| NPI | 1740436120 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS J KING President 708-423-4110 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: IL 019014089) |
| Enumeration Date | 2008-08-17 |
| Last Update Date | 2008-08-17 |