| NPI | 1508006313 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONALD SCOTT JACOBSON President 773-545-5333 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: IL 060.004616) |
| Enumeration Date | 2009-03-06 |
| Last Update Date | 2009-03-06 |