| NPI | 1497025324 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FRED J. MARCHESE Owner 708-343-6065 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: IL 019019113) |
| Enumeration Date | 2012-01-10 |
| Last Update Date | 2012-01-10 |