Organization
EAST DENTAL LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ASHRAF AHMAD (OWNER)
(773) 283-3513
Entity
Organization
Contact information
Practice address
3916 N CICERO AVE, CHICAGO, IL 60641-2709
(773) 283-3513
Mailing address
3916 N CICERO AVE, CHICAGO, IL 60641-2709
(773) 283-3513
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019026287
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1005813
—
IL
Enumeration date
11/01/2008
Last updated
11/01/2008
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