Familia Dental Esl 4 LLC
NPI #1801151063 in East Saint Louis, Illinois
Provider Information
- NPI Number
- 1801151063
- Entity Type
- Organization
- Organization Name
- Familia Dental Esl 4 LLC
- Primary Specialty
- Dentist - General Practice
- Enumeration Date
- Jul 12, 2012
- Last Updated
- Jul 12, 2012
Practice Location
- Address
- 2608 STATE ST
- City
- East Saint Louis
- State
- Illinois
- ZIP Code
- 62205-2325
- Phone
- (888) 988-4066
Authorized Official
- Name
- DR. KOUSHAN AZAD, DMDM
- Title
- PRESIDENT
- Phone
- (888) 988-4066
Specialties & Taxonomy Codes
| Specialty |
|---|
| Dentist - General Practice — General Practice |
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