| Familia Dental Esl 4llc | |
|
2608 State St East Saint Louis IL 62205-2325 | |
| (888) 988-4066 | |
| (847) 496-7202 |
| Full Name | Familia Dental Esl 4llc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 2608 State St, East Saint Louis, Illinois |
| Authorized Official Name and Position | Koushan Azad (PRESIDENT) |
| Authorized Official Contact | 8889884066 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Familia Dental Esl 4llc 2050 E Algonquin Rd 610 Schaumburg IL 60173-4144 Ph: (888) 988-4066 | Familia Dental Esl 4llc 2608 State St East Saint Louis IL 62205-2325 Ph: (888) 988-4066 |
| NPI Number | 1013283126 |
|---|---|
| Provider Enumeration Date | 03/23/2012 |
| Last Update Date | 03/23/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013283126 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 019026920 (Illinois) | Primary |
Familia Dental Esl 4 Llc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 2608 State St, East Saint Louis, IL 62205 Phone: 888-988-4066 Fax: 847-496-7603 | |
Familia Dental Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 2608 State St., East Saint Louis, IL 62205 Phone: 618-857-2300 Fax: 618-857-2302 |