| NPI | 1295906584 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KOUSHAN AZAD Owner/Dentist 815-929-0222 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019026920) |
| Enumeration Date | 2008-03-14 |
| Last Update Date | 2008-03-14 |