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General NPI Number Information
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NPI Number | 1164758058
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Entity Type | Organization
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Legal Business Name | ATASSI ADVANCED DENTAL CARE
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Dates
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Enumeration Date | 10/27/2009
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Last Update Date | 10/27/2009
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Provider Practice Location Address
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Address Line | 801 PLAINFIELD RD
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City | DARIEN
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State | IL
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Zip | 60561-4286
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Country | US
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Telephone | 630-769-9940
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Fax |
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Provider Business Mailing Address
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Address Line | 801 PLAINFIELD RD
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City | DARIEN
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State | IL
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Zip | 60561-4286
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BANA ATASSI
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Credential | DDS
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Telephone | 630-769-9940
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019-026463
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019-023267
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License Number State | IL
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