MEDICARE: SALUD FAMILY DENTAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	019.028486	IL

General Provider Information

NPI Number	:	1063887404
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SALUD FAMILY DENTAL

Provider Business Mailing Address
First Line	:	7714 S CICERO AVE
Second Line	:
City	:	BURBANK
State	:	IL
Zip	:	60459-1583
Country	:	US
Telephone Number	:	708-636-3368
Fax Number	:	708-636-7109

Provider Business Practice Location Address
First Line	:	7714 S CICERO AVE
Second Line	:
City	:	BURBANK
State	:	IL
Zip	:	60459-1583
Country	:	US
Telephone Number	:	708-636-3368
Fax Number	:	708-636-7109

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ASIM M ANSARI
Credential	:	DDS
Telephone Number	:	630-254-9114

Provider Enumeration Date	:	12/10/2015
Last Update Date	:	12/10/2015

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Directions to “SALUD FAMILY DENTAL ” Practice Location

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