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General NPI Number Information
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NPI Number | 1750800546
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Entity Type | Organization
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Legal Business Name | 1ST CHOICE DENTAL
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Dates
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Enumeration Date | 09/13/2017
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Last Update Date | 09/13/2017
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Provider Practice Location Address
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Address Line | 7236 W 87TH ST
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City | BRIDGEVIEW
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State | IL
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Zip | 60455
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Country | US
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Telephone | 708-419-0000
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Fax |
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Provider Business Mailing Address
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Address Line | 7236 W 87TH ST
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City | BRIDGEVIEW
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State | IL
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Zip | 60455
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Country | US
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Telephone | 708-419-0000
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Fax |
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Authorized Official
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Title or Position | DR.
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Name | HUSSEIN LATIF
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Credential | DMD
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Telephone | 708-419-0000
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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 |
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License Number State | IL
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