| NPI | 1861648818 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GINA LYN TAMBORNINI Dentist/President 312-642-4218 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019203206) |
| Enumeration Date | 2008-08-11 |
| Last Update Date | 2012-07-17 |