Healthcare Provider Details

I. General information

NPI: 1497688923
Provider Name (Legal Business Name): DENOVA DENTAL PARTNERS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 E ROOSEVELT RD
LOMBARD IL
60148-4776
US

IV. Provider business mailing address

660 E ROOSEVELT RD
LOMBARD IL
60148-4776
US

V. Phone/Fax

Practice location:
  • Phone: 757-287-5545
  • Fax:
Mailing address:
  • Phone: 630-627-7651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. AMNA ALWALIE
Title or Position: DENTIST
Credential: DMD
Phone: 630-627-7651