| NPI | 1972649200 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | YETTA G MCCULLOM VP And Cheif Finanical Officer 773-488-3738 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2020-08-22 |