Organization
DENTAL IMPRESSION, SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHAFEEQ H BADER DDS (PRESIDENT)
(630) 452-6950
Entity
Organization
Contact information
Practice address
5430 S KEDZIE AVE, CHICAGO, IL 60632-2620
(773) 925-0650
Mailing address
5430 S KEDZIE AVE, CHICAGO, IL 60632-2620
(773) 925-0650
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019025521
IL
Other
Enumeration date
11/01/2011
Last updated
11/01/2011
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