| NPI | 1851785224 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE ANN RADEKA Owner/Pres/Dentist 773-235-2322 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019025071) |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Enumeration Date | 2015-03-24 |
| Last Update Date | 2015-04-23 |