Provider Demographics
NPI:1881128874
Name:ART OF MODERN DENTISTRY
Entity type:Organization
Organization Name:ART OF MODERN DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FARIDEH
Authorized Official - Middle Name:NIKOO
Authorized Official - Last Name:DAFTARY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:312-922-1898
Mailing Address - Street 1:1339 S.MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605
Mailing Address - Country:US
Mailing Address - Phone:312-922-1898
Mailing Address - Fax:312-922-1879
Practice Address - Street 1:1339 S.MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-2601
Practice Address - Country:US
Practice Address - Phone:312-922-1898
Practice Address - Fax:312-922-1879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-17
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190253321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty