Healthcare Provider Details

I. General information

NPI: 1831985928
Provider Name (Legal Business Name): MR TEETH DENTAL AND IMPLANT CO.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2025
Last Update Date: 05/25/2025
Certification Date: 05/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

552 S WASHINGTON ST STE 220
NAPERVILLE IL
60540-6670
US

IV. Provider business mailing address

3203 111TH ST APT 107
NAPERVILLE IL
60564-0006
US

V. Phone/Fax

Practice location:
  • Phone: 617-380-8663
  • Fax: 708-527-0656
Mailing address:
  • Phone: 617-380-8663
  • Fax: 617-380-8663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. HATEM GELANI IX
Title or Position: DENTIST/OWNER
Credential: DDS
Phone: 617-380-8663