| NPI | 1467789867 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHLEEN M HANSEN Sole Member 773-276-3360 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019019366) |
| Enumeration Date | 2009-11-06 |
| Last Update Date | 2009-11-06 |