| NPI | 1669624284 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARYBETH SKINNER Finance/Insurance 708-636-2900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: IL 060-001172) |
| Enumeration Date | 2008-10-14 |
| Last Update Date | 2008-10-29 |