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 |