Organization
PREMIER DENTAL CARE ILLINOIS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HIDAYATHULLA KHAN (OWNER)
(224) 443-4988
Entity
Organization
Contact information
Practice address
1819 CHURCH ST, EVANSTON, IL 60201-3415
(847) 866-7430
Mailing address
1819 CHURCH ST, EVANSTON, IL 60201-3415
(847) 866-7430
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
07/25/2019
Last updated
07/25/2019
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