Organization
MIRUS ORAL HEALTH & ESTHETIC, LLC
Active
Other names
Cornerstone Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
SYED REHMAN DDS (PRESIDENT/OWNER)
(847) 915-2827
Entity
Organization
Contact information
Practice address
1530 LAKE ST, ROSELLE, IL 60172-3330
(630) 529-0900
Mailing address
1530 LAKE ST STE D, ROSELLE, IL 60172-3330
(630) 529-0900
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
IL
261QD0000X
Dental Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
019030260
IL DENTAL LICENSE
IL
Enumeration date
08/14/2014
Last updated
06/11/2019
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