Provider Demographics
NPI:1922547546
Name:FAMILY DENTAL CARE OF BELVIDERE
Entity Type:Organization
Organization Name:FAMILY DENTAL CARE OF BELVIDERE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:FARZIN
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUSEF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-544-3426
Mailing Address - Street 1:860 BIESTER DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BELVIDERE
Mailing Address - State:IL
Mailing Address - Zip Code:61008-4053
Mailing Address - Country:US
Mailing Address - Phone:815-544-3426
Mailing Address - Fax:815-544-3428
Practice Address - Street 1:860 BIESTER DR
Practice Address - Street 2:SUITE 102
Practice Address - City:BELVIDERE
Practice Address - State:IL
Practice Address - Zip Code:61008-4053
Practice Address - Country:US
Practice Address - Phone:815-544-3426
Practice Address - Fax:815-544-3428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-15
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0237221223E0200X, 1223G0001X, 1223P0221X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty