| NPI | 1730273558 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK M STORER Owner 773-763-5353 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 060006717) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2015-08-17 |