| NPI | 1992880140 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | OPHELIA KAY CARLTON Dentist 773-468-4554 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019023713) |
| Enumeration Date | 2006-10-26 |
| Last Update Date | 2022-07-21 |