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Organization
PEARL DENTAL, LLC
Active
Organization
PEARL DENTAL, LLC
Active
Other names
advanced dental makeover
Organization subpart
No
Provider details
NPI number
Authorized official
MR. FAWAZ KANNOUT D.D.S (OWNER)
(773) 604-5050
Entity
Organization
Contact information
Practice address
4707 N PULASKI RD STE 103, CHICAGO, IL 60630-4312
(773) 604-5050
(773) 604-5030
Mailing address
4707 N PULASKI RD STE 103, CHICAGO, IL 60630-4312
(773) 604-5050
(773) 604-5030
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019024870
IL
Other
Enumeration date
10/10/2014
Last updated
10/10/2014
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