| NPI | 1821241290 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDNA DOYLA Treatment Coordinator 224-223-8116 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2008-10-29 |
| Last Update Date | 2013-12-05 |