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Organization
PERIODONTICS & DENTAL IMPLANT CENTER LTD
Active
Organization
PERIODONTICS & DENTAL IMPLANT CENTER LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMJOD ALDOLLAL D.D.S. (PRESIDENT)
(773) 847-9004
Entity
Organization
Contact information
Practice address
1900 W 47TH ST, CHICAGO, IL 60609-3833
(773) 847-9004
(773) 847-9008
Mailing address
1900 W 47TH ST, CHICAGO, IL 60609-3833
(773) 847-9004
(773) 847-9008
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
019028531
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
019028531
—
IL
Enumeration date
03/04/2013
Last updated
03/04/2013
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