MEDICARE: MOHANNAD MUSA D.D.S.

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	019035994	IL

General Provider Information

NPI Number	:	1467245175
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOHANNAD MUSA D.D.S.

Provider Business Mailing Address
First Line	:	14546 S APPALOOSA LN
Second Line	:
City	:	HOMER GLEN
State	:	IL
Zip	:	60491-8303
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	981 W SOUTH ST
Second Line	:
City	:	FREEPORT
State	:	IL
Zip	:	61032-6778
Country	:	US
Telephone Number	:	708-890-4879
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/26/2025
Last Update Date	:	05/26/2025

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Directions to “ MOHANNAD MUSA D.D.S.” Practice Location

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