Organization
CLARK DENTAL OFFICE LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
REZA JALILI KMOSHNOOD DMD (PRESIDENT DENTIST)
(773) 761-2020
Entity
Organization
Contact information
Practice address
6210 N CLARK ST, CHICAGO, IL 60660
(773) 761-2020
(773) 761-2072
Mailing address
6210 N CLARK ST, CHICAGO, IL 60660
(773) 761-2020
(773) 761-2072
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1002509
—
IL
Enumeration date
03/24/2008
Last updated
03/24/2008
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