MEDICARE: DR. FATEMEH SOLMAZ AFSHARI DMD, MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	019027125	IL

General Provider Information

NPI Number	:	1427385087
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FATEMEH SOLMAZ AFSHARI DMD, MS

Provider Business Mailing Address
First Line	:	807 DAVIS ST
Second Line	:	UNIT 1008
City	:	EVANSTON
State	:	IL
Zip	:	60201-4471
Country	:	US
Telephone Number	:	847-691-9407
Fax Number	:

Provider Business Practice Location Address
First Line	:	801 SOUTH PAULINA STREET
Second Line	:	MC 555
City	:	CHICAGO
State	:	IL
Zip	:	60612-7212
Country	:	US
Telephone Number	:	847-691-9407
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/03/2009
Last Update Date	:	11/03/2009

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