Organization
CHICAGO DENTAL COSMETICS
Active
Parent organization
CHICAGO DENTAL COSMETICS
Other names
advanced family dental
Organization subpart
Yes
Provider details
NPI number
Legal business name
CHICAGO DENTAL COSMETICS
Authorized official
MUSTAPHA HOTAIT DDS (PRESIDENT)
(773) 767-1554
Entity
Organization
Contact information
Practice address
6338 S PULASKI RD, CHICAGO, IL 60629-4706
(773) 767-1554
Mailing address
6338 S PULASKI RD, CHICAGO, IL 60629-4706
(773) 767-1554
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019028105
IL
Other
Enumeration date
10/17/2016
Last updated
10/17/2016
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