Healthcare Provider Details

I. General information

NPI: 1902761133
Provider Name (Legal Business Name): MY DENTAL HUB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4905 OLD ORCHARD SHOPPING CTR UNIT 221,
SKOKIE IL
60077
US

IV. Provider business mailing address

4905 OLD ORCHARD SHOPPING CENTER SUITE 221
SKOKIE IL
60077
US

V. Phone/Fax

Practice location:
  • Phone: 847-674-2463
  • Fax:
Mailing address:
  • Phone: 847-674-2463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MOUSTAFA YOUSSEF
Title or Position: DENTIST
Credential: DDS
Phone: 585-309-7431