Healthcare Provider Details

I. General information

NPI: 1376473850
Provider Name (Legal Business Name): SE CHICAGO DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 E ERIE ST STE 406
CHICAGO IL
60611-5955
US

IV. Provider business mailing address

233 E ERIE ST STE 406
CHICAGO IL
60611-5955
US

V. Phone/Fax

Practice location:
  • Phone: 312-587-0200
  • Fax:
Mailing address:
  • Phone: 312-587-0200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. NASRIN AZIMZADEH
Title or Position: DR./OWNER
Credential: DMD
Phone: 312-587-0200