Organization
BRYN MAWR ORAL PATHOLOGY & BIOPSY INC
Active
Other names
Maxillofacial pathology
Organization subpart
No
Provider details
NPI number
Authorized official
DR. REZA MOSTOFI DMD (DIRECTOR)
(773) 267-1110
Entity
Organization
Contact information
Practice address
3407 W BRYN MAWR AVE, CHICAGO, IL 60659-3450
(773) 267-1110
(773) 267-1081
Mailing address
3407 W BRYN MAWR AVE, CHICAGO, IL 60659-3450
(773) 267-1110
(773) 267-1081
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
14D0862191
IL
Other
Enumeration date
06/22/2006
Last updated
08/19/2014
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