| Familia Dental Peoria 5 Llc | |
|
1403 W Glen Ave Peoria IL 61614-4705 | |
| (888) 988-4066 | |
| (847) 496-7603 |
| Full Name | Familia Dental Peoria 5 Llc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1403 W Glen Ave, Peoria, 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 Peoria 5 Llc 2050 E Algonquin Rd Suite 610 Schaumburg IL 60173-4144 Ph: (888) 988-4066 | Familia Dental Peoria 5 Llc 1403 W Glen Ave Peoria IL 61614-4705 Ph: (888) 988-4066 |
| NPI Number | 1568726206 |
|---|---|
| Provider Enumeration Date | 06/27/2012 |
| Last Update Date | 06/27/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568726206 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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