Provider Demographics
NPI:1285023150
Name:BELMONT DENTAL TOWN
Entity Type:Organization
Organization Name:BELMONT DENTAL TOWN
Other - Org Name:DENTAL TOWN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SINAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RAZZAK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:312-810-2948
Mailing Address - Street 1:3600 W BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-5304
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3600 W BELMONT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-5304
Practice Address - Country:US
Practice Address - Phone:708-863-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-15
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190274701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty