Healthcare Provider Details

I. General information

NPI: 1285013664
Provider Name (Legal Business Name): KAREEM HATAHET D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2015
Last Update Date: 04/28/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1259 S WABASH AVE
CHICAGO IL
60605-2412
US

IV. Provider business mailing address

PO BOX 60842
CHICAGO IL
60660-0842
US

V. Phone/Fax

Practice location:
  • Phone: 312-846-6752
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019.035891
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number30.024444
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: