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General NPI Number Information
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NPI Number | 1003461849
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Entity Type | Individual
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Provider Name | HISHAM JOSEPH GHARIB
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Gender | Male
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Dates
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Enumeration Date | 08/08/2019
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Last Update Date | 05/06/2025
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Provider Practice Location Address
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Address Line | 4901 N KEDZIE AVE
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City | CHICAGO
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State | IL
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Zip | 60625-5009
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Country | US
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Telephone | 773-509-9200
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Fax |
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Provider Business Mailing Address
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Address Line | 9433 CHURCHILL DR
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City | HICKORY HILLS
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State | IL
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Zip | 60457-7203
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Country | US
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Telephone | 804-300-8553
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DL14112
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019.033426
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License Number State | IL
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