| Toothtown Dental Addison | |
|
303 W Lake St Ste 300 Addison IL 60101-2564 | |
| (630) 352-1547 | |
| Not Available |
| Full Name | Toothtown Dental Addison |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 303 W Lake St Ste 300, Addison, Illinois |
| Authorized Official Name and Position | Yusuf Fahmy (OWNER) |
| Authorized Official Contact | 6303521547 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Toothtown Dental Addison 1042 N Yale Ave Villa Park IL 60181-1146 Ph: (630) 352-1547 | Toothtown Dental Addison 303 W Lake St Ste 300 Addison IL 60101-2564 Ph: (630) 352-1547 |
| NPI Number | 1508590415 |
|---|---|
| Provider Enumeration Date | 07/15/2022 |
| Last Update Date | 07/15/2022 |
| Certification Date | 07/15/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508590415 | NPI | - | NPPES |
| 019030794 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | () | Primary |
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