Azadeh Mary Afzali, DDS

Individual provider Active NPI General Practice Dentistry · Glenview, IL

NPI 1275796237 · NPPES record last updated Mar 12, 2018

Key facts

NPI
1275796237
Entity type
Individual (NPI type 1)
Primary specialty
General Practice Dentistry 1223G0001X
License
019-022130 (IL)
Practice address
946 Harlem Ave
Glenview, IL 60025-4275
Phone
(847) 724-3969
Fax
(847) 724-3972
NPI assigned
Jul 9, 2008
Sex
Female
Sole proprietor
No

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
Yes

State licenses

LicenseStateTypeSpecialty
019-022130ILMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Azadeh Afzali D.D.S, Inc. General Practice Past
since Dec 15, 2015
Accepting new patients
Afzali Dental Corporation Past
since Feb 1, 2018
Accepting new patients
Glenlake Dental Care PC Past Accepting new patients
Eric Lim, DDS, LTD General Practice Past Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 019-022130 IL Yes

Addresses

Primary practice location

946 Harlem Ave
Glenview, IL 60025-4275

Mailing address

946 Harlem Ave
Glenview, IL 60025-4275
Phone (847) 724-3969

Other providers in Glenview, IL

All providers in Glenview, IL · General Practice Dentistry in Illinois

Sources for this page

Verify at the official NPI Registry.