| NPI | 1740522200 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GLORIA CHAVEZ Access Manager 773-429-1400 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 319027955) |
| Enumeration Date | 2013-03-22 |
| Last Update Date | 2021-07-16 |