| NPI | 1982134672 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK WILKES MORRI Sole Owner/ General Dentist 312-339-0588 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: AZ 9690) |
| Enumeration Date | 2017-06-14 |
| Last Update Date | 2017-06-14 |