Organization
FAMILY DENTAL CLINIC, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MOHAMMAD ZAFFARKHAN (DENTIST)
(773) 463-1904
Entity
Organization
Contact information
Practice address
3211 W LAWRENCE AVE, CHICAGO, IL 60625-5208
(773) 463-1904
(773) 463-1257
Mailing address
3211 W LAWRENCE AVE, CHICAGO, IL 60625-5208
(773) 463-1904
(773) 463-1257
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
01901529
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
14177013061
—
IL
Enumeration date
07/16/2008
Last updated
07/16/2008
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