| NPI | 1982884599 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRYAN A. LIPSON President 708-532-9303 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: IL 019-018278) |
| Enumeration Date | 2007-11-12 |
| Last Update Date | 2007-11-12 |