Healthcare Provider Details

I. General information

NPI: 1922650142
Provider Name (Legal Business Name): URBAN DENTAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2019
Last Update Date: 07/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7451 WOODWARD AVE STE 102
WOODRIDGE IL
60517-2665
US

IV. Provider business mailing address

13328 MISTY MEADOW DR
PALOS HEIGHTS IL
60463-2745
US

V. Phone/Fax

Practice location:
  • Phone: 708-567-5750
  • Fax:
Mailing address:
  • Phone: 708-567-5750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. ALI AOUN
Title or Position: DENTIST
Credential: DMD
Phone: 708-567-5750