| NPI | 1992075972 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAMELA REYNOLDS Dentist/President 708-383-0500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019017700) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019028628) |
| Enumeration Date | 2012-01-06 |
| Last Update Date | 2012-01-06 |