Organization
FAMILIA DENTAL ESL 4LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KOUSHAN AZAD DMD (PRESIDENT)
(888) 988-4066
Entity
Organization
Contact information
Practice address
2608 STATE ST, EAST SAINT LOUIS, IL 62205-2325
(888) 988-4066
(847) 496-7202
Mailing address
2050 E ALGONQUIN RD, 610, SCHAUMBURG, IL 60173-4144
(888) 988-4066
(847) 496-7202
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019026920
IL
Other
Enumeration date
03/23/2012
Last updated
03/23/2012
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