Familia Dental Springfield 2 LLC
NPI #1104109230 in Springfield, Illinois
Provider Information
- NPI Number
- 1104109230
- Entity Type
- Organization
- Organization Name
- Familia Dental Springfield 2 LLC
- Primary Specialty
- Dentist
- Enumeration Date
- Sep 26, 2011
- Last Updated
- Sep 26, 2011
Practice Location
- Address
- 802 N 9TH ST
- City
- Springfield
- State
- Illinois
- ZIP Code
- 62702-6309
- Phone
- (888) 988-4066
Authorized Official
- Name
- DR. KOUSHAN H AZAD, DMD
- Title
- PRESIDENT
- Phone
- (888) 988-4066
Specialties & Taxonomy Codes
| Specialty |
|---|
| Dentist |
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