Individual
AZIZ ROMAN SUSARREY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
7345 W 25TH ST, NORTH RIVERSIDE, IL 60546-1409
(708) 447-0900
Mailing address
350 N CLARK ST FL 6, CHICAGO, IL 60654-4712
(312) 274-4524
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019.032169
IL
Other
Enumeration date
05/10/2018
Last updated
05/06/2024
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