Familia Dental Peoria 5 LLC

NPI #1568726206 in Peoria, Illinois

Provider Information

NPI Number: 1568726206
Entity Type: Organization
Organization Name: Familia Dental Peoria 5 LLC
Primary Specialty: Dentist - General Practice
Enumeration Date: Jun 27, 2012
Last Updated: Jun 27, 2012

Practice Location

Address: 1403 W GLEN AVE
City: Peoria
State: Illinois
ZIP Code: 61614-4705
Phone: (888) 988-4066

Authorized Official

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

Specialties & Taxonomy Codes

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

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