| NPI | 1710386271 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL STEVEN HENDERSON Vice President 773-426-7198 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL HAD64) |
| Enumeration Date | 2014-08-20 |
| Last Update Date | 2014-08-20 |