St. Charles Modern Dental, LLC
NPI #1912220773 in St Charles, Illinois
Provider Information
- NPI Number
- 1912220773
- Entity Type
- Organization
- Organization Name
- St. Charles Modern Dental, LLC
- Primary Specialty
- Dentist - General Practice
- Enumeration Date
- Mar 9, 2010
- Last Updated
- Mar 9, 2010
Practice Location
- Address
- 855 S RANDALL RD
- City
- St Charles
- State
- Illinois
- ZIP Code
- 60174-1570
- Phone
- (630) 587-2700
Authorized Official
- Name
- DR. KIANOR SHAHMOHMMADI, DMD
- Title
- CEO - NEXUS DENTISTRY
- Phone
- (618) 917-5808
Specialties & Taxonomy Codes
| Specialty |
|---|
| Dentist - General Practice — General Practice |
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