| NPI | 1720713993 |
|---|---|
| Doing Business As | DENTAL CLUB ST. CHARLES |
| Entity Type | Organization |
| Authorized Contact | THOMAS J RYAN President 708-305-0729 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2022-07-20 |
| Last Update Date | 2022-07-20 |