| NPI | 1619613775 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALEXANDER MICHAEL SHORE Owner/ President 708-799-5353 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment | |
| Enumeration Date | 2022-05-10 |
| Last Update Date | 2023-02-20 |