| NPI | 1497015721 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | G. R. CLEMENS Dentist 708-795-1255 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 19015658) |
| Enumeration Date | 2012-05-21 |
| Last Update Date | 2012-05-21 |