| NPI | 1740868553 |
|---|---|
| Doing Business As | HALSTED STREET DENTAL |
| Entity Type | Organization |
| Authorized Contact | DARREN DWAYNE SIMPSON Owner 708-369-4076 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2021-04-01 |
| Last Update Date | 2021-04-01 |