Familia Dental Esl 4 LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

FAMILIA DENTAL ESL 4 LLC

Practice address

2608 State St
East Saint Louis, IL 62205-2325

Phone

(888) 988-4066

Fax

(847) 496-7603

NPI assigned

Jul 12, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Koushan Azad, DMDM

Title

President

Phone

(888) 988-4066

Specialties & licenses 1

Addresses

Tax ID family

Familia Dental Esl 4 LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Familia Dental Esl 4LLC

  • General Practice Dentistry
  • East Saint Louis, IL
  • NPI 1013283126
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1342051200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1342051200000",
    "number": "1801151063",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2050 E ALGONQUIN RD",
            "address_2": "SUITE 610",
            "city": "SCHAUMBURG",
            "state": "IL",
            "postal_code": "601734144",
            "telephone_number": "888-988-4066",
            "fax_number": "847-496-7603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2608 STATE ST",
            "city": "EAST SAINT LOUIS",
            "state": "IL",
            "postal_code": "622052325",
            "telephone_number": "888-988-4066",
            "fax_number": "847-496-7603"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILIA DENTAL ESL 4 LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-12",
        "last_updated": "2012-07-12",
        "status": "A",
        "authorized_official_last_name": "AZAD",
        "authorized_official_first_name": "KOUSHAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "888-988-4066",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMDM"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Deborah Dyle, LCSW
• East Side Health District
• East St Louis Dist 189
• Edgemont Pediatrics, P.C
• Cheryl Lynn Eubanks
• Familia Dental Esl 4LLC
• Familia Dental Esl LLC (Familia Dental)
• David Felts
• Jeffrey Fields, RPH
• Wendy Fleming, RN

• General Practice Dentistry in East Saint Louis, IL
• Providers in East Saint Louis, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.