| NPI | 1467466375 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN MARTIN MCCOY Owner 773-286-5935 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: IL 021-001497) |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2008-07-02 |