Independence Family Dental

LBN: Independence Family Dental
Independence Family Dental is an health care organization with primary practice located at 4703 W Lawrence Ave , Chicago IL 60630-1722. The organization recently has only one registered license in Dental Providers / Dentist, which is considered as the primary health care specialty. Independence Family Dental can be contacted via phone (773) 205-9900, or through Azab, Emad E via phone (773) 205-9900.

Contact Information

Primary practice address
4703 W Lawrence Ave Chicago IL 60630-1722
Phone: (773) 205-9900
Fax: (773) 205-9970
Website:
Map and Directions
Authorized official contact:
Name: Azab, Emad E Doctor of Dental Surgery (DDS)
Phone: (773) 205-9900

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Dentist 122300000X Illinois

Profile Details

NPI number 1164406138
LBN Legal business name Independence Family Dental
DBA Doing business as
Authorized official Azab, Emad E Doctor of Dental Surgery (DDS)
Entity Organization
Organization subpart 1 No
Enumeration date Dec 2nd, 2005
Last updated Aug 22nd, 2020 - about 6 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1164406138 NPPES
Illinois MEDICAID 101611

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