| NPI | 1578246930 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CONNIE J WOO Owner 224-612-1383 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2023-08-10 |
| Last Update Date | 2024-01-05 |