Independence Family Dental

NPI #1164406138 in Chicago, Illinois

Provider Information

NPI Number: 1164406138
Entity Type: Organization
Organization Name: Independence Family Dental
Primary Specialty: Dentist
Enumeration Date: Dec 2, 2005
Last Updated: Aug 22, 2020

Practice Location

Address: 4703 W LAWRENCE AVE
City: Chicago
State: Illinois
ZIP Code: 60630-1722
Phone: (773) 205-9900

Authorized Official

Name: EMAD E AZAB, DDS
Title: DENTIST
Phone: (773) 205-9900

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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