| NPI | 1760587448 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MIRA M ISKANDAR President 773-523-7525 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019022657) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019024278) |
| 1223G0001X Dentist, General Practice (Licence: IL 019022761) | |
| 1223G0001X Dentist, General Practice (Licence: IL 019023160) | |
| 124Q00000X Dental Hygienist (Licence: IL 124Q00000x) | |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2020-08-22 |