| NPI | 1679775407 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GUADALUPE GONZALEZ-HOLDERBAUM Office Cooridnator 773-585-5176 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2007-06-04 |
| Last Update Date | 2020-08-22 |