Organization
FAMILA DENTAL MARION LLC
Active
Other names
Familia Dental Marion LLC
Organization subpart
No
Provider details
NPI number
Authorized official
KOUSHAN AZAD (OWNER)
(888) 988-4066
Entity
Organization
Contact information
Practice address
1903 S WESTERN AVE, MARION, IN 46953
(888) 988-4066
(847) 496-7603
Mailing address
1903 S WESTERN AVE, MARION, IN 46953
(888) 988-4066
(847) 496-7603
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
12011918A
IN
Other
Enumeration date
05/22/2013
Last updated
05/22/2013
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