Decatur 2013 LLC

NPI #1568725943 in Decatur, Illinois

Provider Information

NPI Number: 1568725943
Entity Type: Organization
Organization Name: Decatur 2013 LLC
Primary Specialty: Dentist - General Practice
Enumeration Date: Jun 20, 2012
Last Updated: Jun 20, 2012

Practice Location

Address: 141 E PERSHING RD
City: Decatur
State: Illinois
ZIP Code: 62526-3213
Phone: (888) 988-4066

Authorized Official

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

Specialties & Taxonomy Codes

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

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