| NPI | 1942588199 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK HUTTON Program Director 312-926-3264 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: IL 018-001815) |
| Enumeration Date | 2011-07-21 |
| Last Update Date | 2011-07-21 |