Healthcare Provider Details

I. General information

NPI: 1124695655
Provider Name (Legal Business Name): D&D DENTAL,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2021
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3902 HARLEM AVE
LYONS IL
60534-1208
US

IV. Provider business mailing address

3902 HARLEM AVE
LYONS IL
60534-1208
US

V. Phone/Fax

Practice location:
  • Phone: 708-442-1900
  • Fax:
Mailing address:
  • Phone: 708-442-1900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: AHMED M HEGAZY
Title or Position: PRESIDENT
Credential: DMD
Phone: 720-608-3010