NPI | 1659821221 |
---|---|
Entity Type | Organization |
Authorized Contact | MARQUETTA D HALL Billing Specialist 708-856-7556 |
Organization Subpart ? | No |
Primary Taxonomy | 261Q00000X Clinic/Center (Licence: IL 1578936696) |
Additional Taxonomies | 1223D0001X Dentist, Dental Public Health (Licence: IL 1588701452) |
Enumeration Date | 2016-10-07 |
Last Update Date | 2016-10-07 |