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General NPI Number Information
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NPI Number | 1235565110
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Entity Type | Organization
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Legal Business Name | PAYAM REZAI DDS PC
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Dates
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Enumeration Date | 09/23/2013
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Last Update Date | 09/23/2013
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Provider Practice Location Address
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Address Line | 3927 W BELMONT AVE STE 105
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City | CHICAGO
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State | IL
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Zip | 60618-5170
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Country | US
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Telephone | 847-502-2127
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Fax |
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Provider Business Mailing Address
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Address Line | 1901 S CALUMET AVE UNIT 1107
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City | CHICAGO
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State | IL
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Zip | 60616-6008
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Country | US
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Telephone | 847-502-2127
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PAYAM REZAI
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Credential | DDS
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Telephone | 847-502-2127
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 060010572
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License Number State | IL
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