| NPI | 1548484793 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY BETH RECKAMP Office Manager 773-684-5702 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019018517) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019026856) |
| 122300000X Dentist (Licence: IL 019024994) | |
| 122300000X Dentist (Licence: IL 019026908) | |
| 122300000X Dentist (Licence: IL 019018517) | |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2008-07-22 |