Organization
COUNTRYSIDE DENTAL GROUP, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LEILA SHAHBANDAR D.D.S. (PRESIDENT)
(312) 498-2937
Entity
Organization
Contact information
Practice address
6335 JOLIET RD, 200, COUNTRYSIDE, IL 60525-7427
(708) 352-1830
Mailing address
6335 JOLIET RD STE 200, COUNTRYSIDE, IL 60525-3986
(708) 352-1830
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019028019
IL
Other
Enumeration date
06/02/2015
Last updated
08/19/2015
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