Provider Demographics
NPI:1043458599
Name:FAMILY DENTISTRY OF HIGHWOOD
Entity Type:Organization
Organization Name:FAMILY DENTISTRY OF HIGHWOOD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:PROF
Authorized Official - First Name:FARZAD
Authorized Official - Middle Name:
Authorized Official - Last Name:SAED
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:847-681-1000
Mailing Address - Street 1:126 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60040-1122
Mailing Address - Country:US
Mailing Address - Phone:847-681-1000
Mailing Address - Fax:847-681-1001
Practice Address - Street 1:126 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:HIGHWOOD
Practice Address - State:IL
Practice Address - Zip Code:60040-1122
Practice Address - Country:US
Practice Address - Phone:847-681-1000
Practice Address - Fax:847-681-1001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-21
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190207641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty