Organization
FAMILIA DENTAL SPRINGFIELD 3 LLC
Active
Other names
FAMILIA DENTAL
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KOUSHAN H AZAD DMD (PRESIDENT)
(888) 988-4066
Entity
Organization
Contact information
Practice address
802 N 9TH ST, SPRINGFIELD, IL 62702-6309
(888) 988-4066
(847) 496-7202
Mailing address
2050 E ALGONQUIN RD, SUITE 610, SCHAUMBURG, IL 60173-4144
(888) 988-4066
(847) 496-7202
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019026920
IL
Other
Enumeration date
09/26/2011
Last updated
09/26/2011
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