NPI | 1578886214 |
---|---|
Doing Business As | BRIDGEPORT FAMILY DENTAL CENTER |
Entity Type | Organization |
Authorized Contact | STEVEN VONGLUEKIAT Owner 312-791-0920 |
Organization Subpart ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019027344) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019027363) |
Enumeration Date | 2010-03-09 |
Last Update Date | 2010-03-09 |