Organization
KEDZIE 47 DENTAL LLC
Active
Other names
Kedzie47 Dental
Organization subpart
No
Provider details
NPI number
Authorized official
MUZAFFAR MIRZA DDS (PRESIDENT)
(630) 501-0064
Entity
Organization
Contact information
Practice address
4721 S KEDZIE AVE, CHICAGO, IL 60632-3001
(773) 847-4444
(630) 359-4933
Mailing address
4721 S KEDZIE AVE, CHICAGO, IL 60632-3001
(630) 501-0064
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
261QD0000X
Dental Clinic/Center
—
—
Other
Enumeration date
07/23/2020
Last updated
10/28/2021
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