# FAMILIA DENTAL EC LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1992116305
- **Authorized official:** DR. KOUSHAN AZAD DMD (PRESIDENT)
- **Authorized official phone:** (888) 988-4066

## Contact information

- **Practice address:** 4624A MAGOUN AVENUE, EAST CHICAGO, IN 46312
- **Practice address phone:** (888) 988-4066
- **Practice address fax:** (847) 496-7603
- **Mailing address:** 2050 E ALGONQUIN RD, SUITE 610, SCHAUMBURG, IL 60173-4144
- **Mailing address phone:** (888) 988-4066
- **Mailing address fax:** (847) 496-7603

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 05/20/2014
- **Last updated:** 10/22/2014