Organization
DOVER DENTAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARYAM HAFEZI DMD (GENERAL DENTIST)
(630) 851-7878
Entity
Organization
Contact information
Practice address
95 TRADE ST STE 101, AURORA, IL 60504-8296
(630) 851-7878
Mailing address
95 TRADE ST STE 101, AURORA, IL 60504-8296
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
261QD0000X
Dental Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
019025427
—
IL
Enumeration date
02/18/2020
Last updated
03/02/2020
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