Organization
FAMILIA DENTAL MKEMIDTOWN LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KOUSHAN AZAD (OWNER)
(847) 701-1457
Entity
Organization
Contact information
Practice address
5341 W FOND DU LAC AVE, MILWAUKEE, WI 53216-1365
(888) 988-4066
(847) 496-4850
Mailing address
2050 E ALGONQUIN RD, SCHAUMBURG, IL 60173-4144
(888) 988-4066
(847) 496-4850
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
1001130
IL
Other
Enumeration date
06/25/2015
Last updated
06/30/2016
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