Healthcare Provider Details

I. General information

NPI: 1679405575
Provider Name (Legal Business Name): FAMM DENTAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7546 JANES AVE
WOODRIDGE IL
60517-2926
US

IV. Provider business mailing address

7539 160TH ST
TINLEY PARK IL
60477-1318
US

V. Phone/Fax

Practice location:
  • Phone: 708-890-4879
  • Fax:
Mailing address:
  • Phone: 708-890-4879
  • 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: MOHANNAD MUSA
Title or Position: CO-OWNER
Credential: DDS
Phone: 708-890-4879