Individual
LYLA H AZZAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
1177 BLOOMINGDALE RD STE B, GLENDALE HEIGHTS, IL 60139-3402
(630) 866-3000
Mailing address
1177 BLOOMINGDALE RD STE B, GLENDALE HEIGHTS, IL 60139-3402
(630) 866-6000
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019.033
IL
122300000X
Dentist
062029
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/26/2020
Last updated
01/13/2023
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