MEDICARE: THE NILE FAMILY DENTAL INC

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	261QD0000X	Dental Clinic/Center	019031607	IL

General Provider Information

NPI Number	:	1679065791
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE NILE FAMILY DENTAL INC

Provider Business Mailing Address
First Line	:	1111 S LAFLIN ST APT 1316
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60607-4661
Country	:	US
Telephone Number	:	347-977-3608
Fax Number	:

Provider Business Practice Location Address
First Line	:	1111 S LAFLIN ST APT 1316
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60607-4661
Country	:	US
Telephone Number	:	347-977-3608
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	GEORGE RIZKALLA
Credential	:	DMD
Telephone Number	:	347-977-3608

Provider Enumeration Date	:	06/04/2018
Last Update Date	:	06/04/2018

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