| NPI | 1790204386 |
|---|---|
| Doing Business As | THE MAGNIFICENT SMILE |
| Entity Type | Organization |
| Authorized Contact | WILLIAM JOSEPH FRERICKS Owner 312-337-4424 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Enumeration Date | 2017-09-14 |
| Last Update Date | 2022-07-21 |