| NPI | 1861601619 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOUGLAS PRINCE Owner 708-614-9420 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: IL 019014235) |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2020-08-22 |