Organization
ABC DENTAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NADA ZAYZAFOON (OWNER)
(312) 919-6266
Entity
Organization
Contact information
Practice address
4608 W DIVERSEY AVE, CHICAGO, IL 60639-1801
(312) 919-6266
Mailing address
4608 W DIVERSEY AVE, CHICAGO, IL 60639-1801
(312) 919-6266
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
19026509
IL
Other
Enumeration date
04/28/2015
Last updated
04/28/2015
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