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Organization
DENTAL SHINE III P C
Active
Organization
DENTAL SHINE III P C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FIRAS EL-MUQDAD (PRESIDENT)
(773) 776-6666
Entity
Organization
Contact information
Practice address
2902 W 63RD ST., CHICAGO, IL 60629
(773) 776-6666
Mailing address
2902 W 63RD ST., CHICAGO, IL 60629
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
019026154
IL
Other
Enumeration date
10/15/2009
Last updated
10/15/2009
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