Organization
ELITE CARE DENTAL, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHAFAQ MUSTAFA (DENTIST/OWNER)
(708) 339-9999
Entity
Organization
Contact information
Practice address
16111 LA SALLE ST, SOUTH HOLLAND, IL 60473-2064
(708) 339-9999
Mailing address
16111 LA SALLE ST, SOUTH HOLLAND, IL 60473-2064
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019-026564
IL
Other
Enumeration date
11/11/2009
Last updated
11/11/2009
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