NPI | 1972649200 |
---|---|
Entity Type | Organization |
Authorized Contact | YETTA G MCCULLOM VP And Cheif Finanical Officer 773-488-3738 |
Organization Subpart ? | No |
Primary Taxonomy | 1223P0300X Dentist, Periodontics |
Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
Enumeration Date | 2007-01-30 |
Last Update Date | 2025-09-11 |