| NPI | 1467643023 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SCOTT WAYNE STIFFLE Dentist 773-348-0565 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019.017448) |
| Enumeration Date | 2007-08-07 |
| Last Update Date | 2007-08-07 |