Organization
CONSUMATE DENTAL P.C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MOEEN IKRAM (PRESIDENT)
(773) 398-5822
Entity
Organization
Contact information
Practice address
825 E ROLLINS RD, ROUND LAKE BEACH, IL 60073-2244
(773) 398-5822
(630) 428-2182
Mailing address
825 E ROLLINS RD, ROUND LAKE BEACH, IL 60073-2244
(773) 398-5822
(630) 428-2182
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019026480
IL
Other
Enumeration date
06/05/2012
Last updated
06/05/2012
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