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NPI Code Detail

MEDICARE: ADVANCED DENTISTRY AT MORTON GROVE

MEDICARE: ADVANCED DENTISTRY AT MORTON GROVE
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
1122300000XDentist019.027311IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1184866329
Entity Type Code : Organization
Provider Name (Legal Business Name) : ADVANCED DENTISTRY AT MORTON GROVE
Provider Business Mailing Address
First Line : 5821 DEMPSTER ST
Second Line :
City : MORTON GROVE
State : IL
Zip : 60053-3028
Country : US
Telephone Number : 847-581-1942
Fax Number : 847-581-1943
Provider Business Practice Location Address
First Line : 5821 DEMPSTER ST
Second Line :
City : MORTON GROVE
State : IL
Zip : 60053-3028
Country : US
Telephone Number : 847-581-1942
Fax Number : 847-581-1943
Authorized Official
Title or Position : PRESIDENT
Name : BEHZAD SANEI
Credential : DMD
Telephone Number : 773-383-0868
Provider Enumeration Date : 04/02/2009
Last Update Date : 03/11/2020

Similar Medicare Providers

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1912286535 — ARDA PAYLAN DDS
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Directions to “ADVANCED DENTISTRY AT MORTON GROVE ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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