| NPI | 1861604936 |
|---|---|
| Doing Business As | HALSTED STREET DENTAL |
| Entity Type | Organization |
| Authorized Contact | ERNEST JERCINOVIC President 773-935-4444 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019023729) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2020-08-22 |