| NPI | 1811055072 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARYLENE VITIELLO President Of Corporation 773-327-3331 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2020-08-22 |