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1421 N Lewis Ave Waukegan IL 60085-1757 | |
| (415) 890-6337 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 1421 N Lewis Ave, Waukegan, Illinois |
| Authorized Official Name and Position | Annie Mirza (OWNER) |
| Authorized Official Contact | 4158906337 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
5845 W Foster Ave Chicago IL 60630-4635 Ph: () - | 1421 N Lewis Ave Waukegan IL 60085-1757 Ph: (415) 890-6337 |
| NPI Number | 1417440611 |
|---|---|
| Provider Enumeration Date | 06/12/2018 |
| Last Update Date | 06/12/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417440611 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
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