| NPI | 1841464989 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRI CRUZ Office Manager 773-583-4455 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019023027) |
| Enumeration Date | 2008-04-19 |
| Last Update Date | 2008-04-19 |