| NPI | 1457775710 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BUDI KUSNOTO President 312-804-8304 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: IL 019026824) |
| Enumeration Date | 2014-02-07 |
| Last Update Date | 2014-02-07 |