Provider Demographics
NPI:1467337964
Name:4 RIVERS DENTAL LTD
Entity type:Organization
Organization Name:4 RIVERS DENTAL LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD MOEIN
Authorized Official - Middle Name:
Authorized Official - Last Name:AZIMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-999-9637
Mailing Address - Street 1:1917 W RACE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-6249
Mailing Address - Country:US
Mailing Address - Phone:847-559-9550
Mailing Address - Fax:
Practice Address - Street 1:840 WILLOW RD STE H
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-6823
Practice Address - Country:US
Practice Address - Phone:847-559-9550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-06
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty