Organization
ART OF MODERN DENTISTRY, P.C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FARIDEH NIKOO DAFTARY D.D.S (OWNER)
(312) 922-1898
Entity
Organization
Contact information
Practice address
3056 N SOUTHPORT AVE, CHICAGO, IL 60657-4218
(773) 935-3600
(312) 922-1879
Mailing address
3056 N SOUTHPORT AVE, CHICAGO, IL 60657-4218
(773) 935-3600
(312) 922-1879
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019025332
IL
Other
Enumeration date
04/20/2017
Last updated
04/20/2017
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