| NPI | 1659645182 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BONCIEL LATRICE GRIFFIN Orthodontist 773-239-7696 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: IL 021002361) |
| Enumeration Date | 2012-03-01 |
| Last Update Date | 2012-03-01 |