Provider Demographics
NPI:1871797308
Name:ARTISTIC COSMETIC DENTISTRY
Entity type:Organization
Organization Name:ARTISTIC COSMETIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NASRIN
Authorized Official - Middle Name:
Authorized Official - Last Name:AZIMZADEH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:847-296-3200
Mailing Address - Street 1:1455 E GOLF RD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-1250
Mailing Address - Country:US
Mailing Address - Phone:847-296-3200
Mailing Address - Fax:847-296-3205
Practice Address - Street 1:1455 E GOLF RD
Practice Address - Street 2:SUITE 209
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-1250
Practice Address - Country:US
Practice Address - Phone:847-296-3200
Practice Address - Fax:847-296-3205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190248831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty