| NPI | 1457026015 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GRACE TRAVERS Owner Dentist 312-342-2299 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2021-08-14 |
| Last Update Date | 2021-11-16 |