Familia Dental Peoria 4 LLC

NPI #1548580780 in Peoria, Illinois

Provider Information

NPI Number: 1548580780
Entity Type: Organization
Organization Name: Familia Dental Peoria 4 LLC
Primary Specialty: Dentist - General Practice
Enumeration Date: Jun 10, 2010
Last Updated: Jun 10, 2010

Practice Location

Address: 1403 W. GLEN
City: Peoria
State: Illinois
ZIP Code: 61614
Phone: (888) 988-4066

Authorized Official

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

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - General Practice — General Practice	1223G0001X	Primary

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