Organization
FAMILIA DENTAL PEORIA 5 LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KOUSHAN AZAD DMD (PRESIDENT)
(888) 988-4066
Entity
Organization
Contact information
Practice address
1403 W GLEN AVE, PEORIA, IL 61614-4705
(888) 988-4066
(847) 496-7603
Mailing address
2050 E ALGONQUIN RD, SUITE 610, SCHAUMBURG, IL 60173-4144
(888) 988-4066
(847) 496-7603
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
06/27/2012
Last updated
06/27/2012
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