| NPI | 1447706494 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACKIE JONES Manager 773-687-8052 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019-026174) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019-029332) |
| 1223G0001X Dentist, General Practice (Licence: IL 019-030017) | |
| Enumeration Date | 2016-08-30 |
| Last Update Date | 2016-08-30 |