| NPI | 1730467796 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REGINALD T BAKER CEO 773-375-0303 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019025166) |
| Enumeration Date | 2011-07-25 |
| Last Update Date | 2011-07-25 |