Organization
ART OF MODERN DENTISTRY PEDIATRICS P.C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FARIDEH NIKOO DAFTARY DDS (OWNER/DENTIST)
(312) 922-1898
Entity
Organization
Contact information
Practice address
1510 S WABASH AVE, CHICAGO, IL 60605-2809
(312) 922-1898
(312) 922-1879
Mailing address
1510 S WABASH AVE, CHICAGO, IL 60605-2809
(312) 922-1898
(312) 922-1879
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019025332
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
019025332
—
IL
Enumeration date
06/30/2014
Last updated
06/30/2014
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