| NPI | 1952676652 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARGIE L MANNERING Dentist 312-456-0221 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 19017234) |
| Enumeration Date | 2012-03-13 |
| Last Update Date | 2012-03-13 |