Organization
DECATUR 2014
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KOUSHAN AZAD DMD (OENWR /PRESIDENT)
(888) 988-4066
Entity
Organization
Contact information
Practice address
141 E PERSHING RD, SUITE 610, DECATUR, IL 62526-3213
(888) 988-4066
(847) 496-7603
Mailing address
2050 E ALGONQUIN RD, SUITE 610, SCHAUMBURG, IL 60173-4144
(888) 988-4066
(847) 496-7603
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
06/20/2012
Last updated
06/20/2012
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