Organization
FAMILIA DENTAL GARY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KOUSHAN AZAD DMD (PRESIDENT)
(888) 988-4066
Entity
Organization
Contact information
Practice address
1320 BROADWAY, GARY, IN 46407-1309
(888) 988-4066
(847) 496-7603
Mailing address
2050 E ALGONQUIN RD, SUITE 610, SCHAUMBURG, IL 60173-4144
(888) 988-4066
(847) 496-7603
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
05/19/2014
Last updated
10/22/2014
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