Park West Family Dentistry, PC

NPI #1053753699 in Chicago, Illinois

Provider Information

NPI Number: 1053753699
Entity Type: Organization
Organization Name: Park West Family Dentistry, PC
Subpart: Yes (part of a larger organization)
Parent Organization: PARK WEST FAMILY DENTISTRY, PC
Primary Specialty: Dentist
Enumeration Date: Jul 24, 2013
Last Updated: Jul 24, 2013

Practice Location

Address: 4909 W DIVISION ST
Address 2: #409
City: Chicago
State: Illinois
ZIP Code: 60651-3161
Phone: (773) 378-4608

Authorized Official

Name: DR. FARIHA SIDDIQUI IMAM, D.D.S.
Title: DENTIST/OWNER
Phone: (773) 880-6054

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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