| Familia Dental | |
|
1403 W. Glen Peoria IL 61614 | |
| (888) 988-4066 | |
| Not Available |
| Full Name | Familia Dental |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1403 W. Glen, Peoria, Illinois |
| Authorized Official Name and Position | Koushan H. Azad (PRESIDENT/OWNER) |
| Authorized Official Contact | 8889884066 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Familia Dental 2000 E Algonquien Rd Suite 109 Schaumburg IL 60173-4189 Ph: (888) 988-4066 | Familia Dental 1403 W. Glen Peoria IL 61614 Ph: (888) 988-4066 |
| NPI Number | 1740500974 |
|---|---|
| Provider Enumeration Date | 06/10/2010 |
| Last Update Date | 06/10/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740500974 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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