Organization
DENTUM DENTAL LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. FAIZAN MIR (MANAGER)
(312) 949-9000
Entity
Organization
Contact information
Practice address
5500 S DAMEN AVE, CHICAGO, IL 60636-1107
(312) 949-9000
Mailing address
319 N WEBER RD # 397, BOLINGBROOK, IL 60490-1569
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019020204
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
019020204
—
IL
Enumeration date
03/12/2018
Last updated
05/11/2018
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