Healthcare Provider Details

I. General information

NPI: 1710143177
Provider Name (Legal Business Name): MAHER JANDALI RIFAI DMD, MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2008
Last Update Date: 03/24/2021
Certification Date: 03/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 WEST MARTIN AVE SUITE 164
NAPERVILLE IL
60540-1334
US

IV. Provider business mailing address

10 WEST MARTIN AVE SUITE 164
NAPERVILLE IL
60540-1334
US

V. Phone/Fax

Practice location:
  • Phone: 630-961-5151
  • Fax:
Mailing address:
  • Phone: 630-961-5151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN1857164
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: