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Organization
PRISTINE DENTAL P C
Active
Organization
PRISTINE DENTAL P C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MOEEN IKRAM (PRESIDENT)
(773) 398-5822
Entity
Organization
Contact information
Practice address
159 N NELTNOR BLVD UNIT 100, WEST CHICAGO, IL 60185-2315
(773) 398-5822
Mailing address
159 N NELTNOR BLVD UNIT 100, WEST CHICAGO, IL 60185-2315
(773) 398-5822
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019026480
IL
Other
Enumeration date
12/16/2008
Last updated
12/16/2008
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