Provider Demographics
NPI:1356818207
Name:ADVANCE FAMILY DENTAL CARE, LTD.
Entity Type:Organization
Organization Name:ADVANCE FAMILY DENTAL CARE, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:PIROOZ
Authorized Official - Middle Name:
Authorized Official - Last Name:ZOMORRODI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-802-3515
Mailing Address - Street 1:105 REVERE DR STE E
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-1594
Mailing Address - Country:US
Mailing Address - Phone:224-282-8191
Mailing Address - Fax:224-282-8167
Practice Address - Street 1:105 REVERE DR STE E
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-1594
Practice Address - Country:US
Practice Address - Phone:224-282-8191
Practice Address - Fax:224-282-8167
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVANCE FAMILY DENTAL CARE, LTD.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-10-30
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty