Healthcare Provider Details

I. General information

NPI: 1841105996
Provider Name (Legal Business Name): IBTISAM ABDALLAH DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7895 W 159TH ST
TINLEY PARK IL
60477-1343
US

IV. Provider business mailing address

5 SILO RIDGE RD S
ORLAND PARK IL
60467-7333
US

V. Phone/Fax

Practice location:
  • Phone: 708-429-4822
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019037444
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: