Organization
MIDWAY FAMILY DENTAL, LLC
Active
Other names
63 Family Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GHAZAL S KERMANI DDS (MANAGER/OWNER)
(949) 701-5320
Entity
Organization
Contact information
Practice address
6258 S PULASKI RD, CHICAGO, IL 60629-4610
(773) 777-6363
Mailing address
6258 S PULASKI RD, CHICAGO, IL 60629-4610
(773) 777-6363
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
05/30/2019
Last updated
05/30/2019
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