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Organization

FAMILIA DENTAL 3 LLC

Active
Other names
FAMILIA DENTAL
Organization subpart
No

Provider details

NPI number
Authorized official
DR. KOUSHAN AZAD DMD (PRESIDENT)
(888) 988-4066
Entity
Organization

Contact information

Practice address
200 W LAKE ST, ADDISON, IL 60101-2513
(888) 988-4066
(847) 496-7202
Mailing address
2050 E ALGONQUIN RD, 610, SCHAUMBURG, IL 60173-4144
(888) 988-4066
(847) 496-7202

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019026920
IL

Other

Enumeration date
02/29/2012
Last updated
02/29/2012
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