Organization
FAMILIA DENTAL PEORIA 3 LLC
Active
Other names
FAMILIA DENTAL
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KOUSHAN H. AZAD DMD (PRESIDENT/OWNER)
(888) 988-4066
Entity
Organization
Contact information
Practice address
1403 W. GLEN, PEORIA, IL 61614
(888) 988-4066
Mailing address
2000 E ALGONQUIN RD SUITE 109, SCHAUMBURG, IL 60173-4189
(888) 988-4066
(847) 496-7603
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
06/10/2010
Last updated
06/10/2010
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