Healthcare Provider Details

I. General information

NPI: 1306687785
Provider Name (Legal Business Name): TODO DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2024
Last Update Date: 09/26/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3750 W 26TH ST
CHICAGO IL
60623-3826
US

IV. Provider business mailing address

1742 ELYSE LN
NAPERVILLE IL
60565-4420
US

V. Phone/Fax

Practice location:
  • Phone: 773-522-0855
  • Fax:
Mailing address:
  • Phone: 646-270-0496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. AHMED M HEGAZY
Title or Position: CEO
Credential: DMD
Phone: 646-270-0496