| NPI | 1700176435 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SAMMY A ELMOSA Owner 708-952-0000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019025131) |
| Enumeration Date | 2011-04-14 |
| Last Update Date | 2011-04-14 |