MEDICARE: DENTALAVEINC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry
2	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1164202719
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTALAVEINC

Provider Business Mailing Address
First Line	:	7608 W 95TH ST
Second Line	:
City	:	HICKORY HILLS
State	:	IL
Zip	:	60457-2203
Country	:	US
Telephone Number	:	708-737-5459
Fax Number	:

Provider Business Practice Location Address
First Line	:	7608 W 95TH ST
Second Line	:
City	:	HICKORY HILLS
State	:	IL
Zip	:	60457-2203
Country	:	US
Telephone Number	:	708-737-5459
Fax Number	:

Authorized Official
Title or Position	:	DOCTOR
Name	:	MAGDI IBRAHIM
Credential	:	DMD
Telephone Number	:	708-737-5457

Provider Enumeration Date	:	10/02/2023
Last Update Date	:	02/27/2024

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Directions to “DENTALAVEINC ” Practice Location

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