Provider Demographics
NPI:1144618000
Name:AMIR SEIFI, DDS, PC
Entity Type:Organization
Organization Name:AMIR SEIFI, DDS, PC
Other - Org Name:FOUR LAKES DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:SEIFI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-231-2537
Mailing Address - Street 1:859 E BELVIDERE RD
Mailing Address - Street 2:
Mailing Address - City:GRAYSLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60030-2581
Mailing Address - Country:US
Mailing Address - Phone:847-231-2537
Mailing Address - Fax:
Practice Address - Street 1:859 E BELVIDERE RD
Practice Address - Street 2:
Practice Address - City:GRAYSLAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-2581
Practice Address - Country:US
Practice Address - Phone:847-231-2537
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-30
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019028892122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty