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General NPI Number Information
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NPI Number | 1336537588
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Entity Type | Organization
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Legal Business Name | FAMILY&PEDIATRIC DENTAL, INC
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Dates
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Enumeration Date | 12/22/2014
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Last Update Date | 12/22/2014
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Provider Practice Location Address
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Address Line | 381 W NORTHWEST HWY
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City | PALATINE
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State | IL
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Zip | 60067-2414
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Country | US
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Telephone | 773-679-2419
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Fax |
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Provider Business Mailing Address
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Address Line | 8418 W CRAIN ST
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City | NILES
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State | IL
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Zip | 60714-1845
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Country | US
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Telephone | 773-679-2419
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Fax | 773-561-5517
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Authorized Official
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Title or Position | GENERAL MANAGER
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Name | MRS. OLENA OBEID
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Credential |
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Telephone | 773-679-2419
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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 | 019.028238
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License Number State | IL
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