| NPI | 1952619355 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT GOVONI Owner 773-281-9800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019026662) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: IL 021002151) |
| Enumeration Date | 2010-09-20 |
| Last Update Date | 2010-09-20 |