| Advanced Dental Makeover | |
|
4707 N Pulaski Rd Ste 103 Chicago IL 60630-4312 | |
| (773) 604-5050 | |
| (773) 604-5030 |
| Full Name | Advanced Dental Makeover |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 4707 N Pulaski Rd Ste 103, Chicago, Illinois |
| Authorized Official Name and Position | Fawaz Kannout (OWNER) |
| Authorized Official Contact | 7736045050 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Advanced Dental Makeover 4707 N Pulaski Rd Ste 103 Chicago IL 60630-4312 Ph: (773) 604-5050 | Advanced Dental Makeover 4707 N Pulaski Rd Ste 103 Chicago IL 60630-4312 Ph: (773) 604-5050 |
| NPI Number | 1821492463 |
|---|---|
| Provider Enumeration Date | 10/10/2014 |
| Last Update Date | 10/10/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821492463 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 019024870 (Illinois) | Primary |
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