Healthcare Provider Details

I. General information

NPI: 1790423374
Provider Name (Legal Business Name): DANA LABABIDI DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2022
Last Update Date: 07/11/2022
Certification Date: 07/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15894 S LA GRANGE RD
ORLAND PARK IL
60467-5563
US

IV. Provider business mailing address

6859 CHILLINGSWORTH CIR NW
CANTON OH
44718-1571
US

V. Phone/Fax

Practice location:
  • Phone: 708-737-5325
  • Fax:
Mailing address:
  • Phone: 330-232-6826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019.033816
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: