Individual
DR. KOUSHAN HAIDARZADEH AZAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
2240 S CICERO AVE, CICERO, IL 60804-2411
(706) 656-2222
(708) 652-3990
Mailing address
312 JUSTINA ST, HINSDALE, IL 60521-2417
(630) 706-0647
(708) 652-3990
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019026920
IL
Other
Enumeration date
05/03/2007
Last updated
07/08/2007
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