Healthcare Provider Details

I. General information

NPI: 1043458599
Provider Name (Legal Business Name): FAMILY DENTISTRY OF HIGHWOOD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2009
Last Update Date: 01/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 WASHINGTON AVE
HIGHWOOD IL
60040-1122
US

IV. Provider business mailing address

126 WASHINGTON AVE
HIGHWOOD IL
60040-1122
US

V. Phone/Fax

Practice location:
  • Phone: 847-681-1000
  • Fax: 847-681-1001
Mailing address:
  • Phone: 847-681-1000
  • Fax: 847-681-1001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019020764
License Number StateIL

VIII. Authorized Official

Name: PROF. FARZAD SAED
Title or Position: OWNER
Credential: DMD
Phone: 847-681-1000