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