Healthcare Provider Details

I. General information

NPI: 1174449102
Provider Name (Legal Business Name): TALA ELFAKI DMD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2604 W NORTH AVE
CHICAGO IL
60647-5235
US

IV. Provider business mailing address

1210 ROSE DR
SYCAMORE IL
60178-9506
US

V. Phone/Fax

Practice location:
  • Phone: 773-252-0033
  • Fax:
Mailing address:
  • Phone: 815-981-0493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: TALA ELFAKI
Title or Position: DMD
Credential: DMD
Phone: 815-981-0493