| NPI | 1639217961 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANTOINETTE MARION PETTITT President 773-994-4433 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: IL 021001448) |
| Enumeration Date | 2007-02-01 |
| Last Update Date | 2020-08-22 |