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NPI Code Detail

MEDICARE: ARDA PAYLAN DDS

MEDICARE: ARDA PAYLAN DDS
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
1122300000XDentist019028699IL

General Provider Information

NPI Number : 1912286535
Entity Type Code : Individual
Provider Name (Legal Business Name) : ARDA PAYLAN DDS
Provider Business Mailing Address
First Line : 9621 LE CLAIRE AVE
Second Line :
City : SKOKIE
State : IL
Zip : 60077-1221
Country : US
Telephone Number :
Fax Number :
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 :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/13/2011
Last Update Date : 08/13/2011

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