Healthcare Provider Details

I. General information

NPI: 1629215199
Provider Name (Legal Business Name): APEX DENTAL STUDIO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2009
Last Update Date: 06/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

346 N LAGRANGE RD
FRANKFORT IL
60423-2008
US

IV. Provider business mailing address

346 N LAGRANGE RD
FRANKFORT IL
60423-2008
US

V. Phone/Fax

Practice location:
  • Phone: 815-464-1200
  • Fax: 815-464-1291
Mailing address:
  • Phone: 815-464-1200
  • Fax: 815-464-1291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019027085
License Number StateIL

VIII. Authorized Official

Name: SYED BILAL YUSAF
Title or Position: PRESIDENT
Credential: DDS
Phone: 815-464-1200