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General NPI Number Information
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NPI Number | 1053609701
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Entity Type | Organization
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Legal Business Name | HICHAM RIBA DDS P.C.
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Dates
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Enumeration Date | 07/15/2011
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Last Update Date | 11/08/2013
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Provider Practice Location Address
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Address Line | 2556 W NORTH AVE
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City | CHICAGO
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State | IL
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Zip | 60647
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Country | US
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Telephone | 773-360-1281
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Fax | 773-360-1285
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Provider Business Mailing Address
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Address Line | 2556 W NORTH AVE
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City | CHICAGO
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State | IL
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Zip | 60647
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Country | US
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Telephone | 773-360-1281
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Fax | 773-360-1285
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Authorized Official
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Title or Position | OPERATIONS MANAGER
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Name | MRS. ALICIA C KIEFFER
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Credential |
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Telephone | 708-819-0515
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019024373
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License Number State | IL
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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 | 019024373
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License Number State | IL
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