Individual
DR. IDEEN MODARRES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
801 S PAULINA ST, CHICAGO, IL 60612-7210
(312) 996-7555
Mailing address
11013 PICASSO LN, POTOMAC, MD 20854-1713
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019.035125
IL
Other
Enumeration date
04/11/2023
Last updated
04/20/2025
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