| NPI | 1629812789 |
|---|---|
| Doing Business As | BUCKTOWN WICKER PARK DENTAL |
| Entity Type | Organization |
| Authorized Contact | DEE REMENIUS General Manager 219-980-0319 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2024-06-24 |
| Last Update Date | 2024-06-24 |