| NPI | 1457849960 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LOGESH SWAYAMPRAKASAM Periodontist 224-877-0645 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: CA DDS100140) |
| Enumeration Date | 2018-04-30 |
| Last Update Date | 2018-04-30 |