Organization
CHICAGO FAMILY DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FARIDEH NIKOO DAFTARY D.D.S (OWNER)
(312) 922-1898
Entity
Organization
Contact information
Practice address
1510 S WABASH AVE, CHICAGO, IL 60605-2809
(312) 341-1115
(312) 922-1879
Mailing address
1510 S WABASH AVE, CHICAGO, IL 60605-2809
(312) 341-1115
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019025332
IL
Other
Enumeration date
04/20/2017
Last updated
04/20/2017
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