| NPI | 1518370832 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES POULOS President 708-865-2225 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019020091) |
| Enumeration Date | 2014-06-04 |
| Last Update Date | 2014-10-13 |