| NPI | 1821562323 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYAN E BOOTH Owner/Orthodontist 708-301-0005 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2019-01-17 |
| Last Update Date | 2019-01-17 |