Familia Dental Esl 2 LLC

NPI #1215210349 in E Saint Louis, Illinois

Provider Information

NPI Number
1215210349
Entity Type
Organization
Organization Name
Familia Dental Esl 2 LLC
Primary Specialty
Dentist - General Practice
Enumeration Date
Sep 26, 2011
Last Updated
Sep 26, 2011

Practice Location

Address
2608 STATE ST
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
Dentist - General PracticeGeneral Practice

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