| NPI | 1942606645 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SYRETTA WELLS Dentist 312-371-1423 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: GA DN013505) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: GA DN013505) |
| 1223P0700X Dentist, Prosthodontics (Licence: GA DN013505) | |
| Enumeration Date | 2014-11-07 |
| Last Update Date | 2014-11-07 |