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General NPI Number Information
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NPI Number | 1417440611
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Entity Type | Organization
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Legal Business Name | AMDENTAL INC
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Dates
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Enumeration Date | 06/12/2018
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Last Update Date | 06/12/2018
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Provider Practice Location Address
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Address Line | 1421 N LEWIS AVE
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City | WAUKEGAN
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State | IL
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Zip | 60085-1757
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Country | US
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Telephone | 415-890-6337
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Fax |
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Provider Business Mailing Address
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Address Line | 5845 W FOSTER AVE
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City | CHICAGO
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State | IL
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Zip | 60630-4635
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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 | DR. ANNIE MIRZA
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Credential | DDS
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Telephone | 415-890-6337
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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