Provider Demographics
NPI:1871845131
Name:BEDFORD DENTAL LLC
Entity Type:Organization
Organization Name:BEDFORD DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SINAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RAZZAK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:312-810-2948
Mailing Address - Street 1:7250 S CICERO AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60629-5849
Mailing Address - Country:US
Mailing Address - Phone:312-810-2948
Mailing Address - Fax:
Practice Address - Street 1:7250 S CICERO AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60629-5849
Practice Address - Country:US
Practice Address - Phone:312-810-2948
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-11
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190274701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty