Provider Demographics
NPI:1053557512
Name:SUZY AZLEA DMD LTD
Entity type:Organization
Organization Name:SUZY AZLEA DMD LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICEE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNADEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-739-9430
Mailing Address - Street 1:761 E BOUGHTON RD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-2281
Mailing Address - Country:US
Mailing Address - Phone:630-739-9430
Mailing Address - Fax:630-739-9427
Practice Address - Street 1:761 E BOUGHTON RD
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-2281
Practice Address - Country:US
Practice Address - Phone:630-739-9430
Practice Address - Fax:630-739-9427
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:YES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-05
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty