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General NPI Number Information
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NPI Number | 1437406311
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Entity Type | Organization
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Legal Business Name | ADVANCED DENTAL
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Dates
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Enumeration Date | 08/09/2012
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Last Update Date | 03/27/2018
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Provider Practice Location Address
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Address Line | 2335 W FULLERTON AVE
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City | CHICAGO
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State | IL
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Zip | 60647-3225
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Country | US
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Telephone | 773-249-4700
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Fax |
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Provider Business Mailing Address
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Address Line | 2335 W FULLERTON AVE
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City | CHICAGO
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State | IL
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Zip | 60647-3225
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Country | US
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Telephone | 773-249-4700
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | NILOFER KHAN
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Credential | DDS
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Telephone | 847-814-6456
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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 | 019028416
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License Number State | IL
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