Familia Dental Esl 3 LLC

NPI #1205119336 in E Saint Louis, Illinois

Provider Information

NPI Number: 1205119336
Entity Type: Organization
Organization Name: Familia Dental Esl 3 LLC
Primary Specialty: Dentist
Enumeration Date: Sep 26, 2011
Last Updated: Sep 26, 2011

Practice Location

Address: 2608 STATE ST
City: E Saint Louis
State: Illinois
ZIP Code: 62205-2325
Phone: (888) 988-4066

Authorized Official

Name: DR. KOUSHAN H AZAD, DMD
Title: PRESIDENT
Phone: (888) 988-4066

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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