| NPI | 1609565910 |
|---|---|
| Doing Business As | MODERN DENTISTRY |
| Entity Type | Organization |
| Authorized Contact | BRAD WISOWATY Member 708-945-5405 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2023-05-03 |
| Last Update Date | 2023-05-03 |