Organization
LARAMIE DENTAL CARE CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARYAM MOGHADAM DDS (PRESIDENT)
(773) 889-3333
Entity
Organization
Contact information
Practice address
2556 N LARAMIE AVE, CHICAGO, IL 60639-2452
(773) 889-3333
Mailing address
2556 N LARAMIE AVE, CHICAGO, IL 60639-2452
(773) 889-3333
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
019025838
IL
Other
Enumeration date
08/18/2009
Last updated
08/18/2009
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