Healthcare Provider Details

I. General information

NPI: 1215458468
Provider Name (Legal Business Name): ABDULKADER GHADIALI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2017
Last Update Date: 01/05/2025
Certification Date: 01/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16523 106TH CT UNIT C2
ORLAND PARK IL
60467-4545
US

IV. Provider business mailing address

16523 106TH CT UNIT C2
ORLAND PARK IL
60467-4545
US

V. Phone/Fax

Practice location:
  • Phone: 708-942-8154
  • Fax: 708-551-0753
Mailing address:
  • Phone: 708-942-8154
  • Fax: 708-551-0753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number101707
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number019.031244
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: