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General NPI Number Information
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NPI Number | 1164378600
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Entity Type | Organization
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Legal Business Name | CHICAGO STAR DENTAL PC
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Dates
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Enumeration Date | 03/06/2026
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Last Update Date | 03/06/2026
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Provider Practice Location Address
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Address Line | 3641 E 108TH ST
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City | CHICAGO
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State | IL
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Zip | 60617-6951
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Country | US
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Telephone | 708-351-4562
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Fax |
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Provider Business Mailing Address
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Address Line | 3641 E 108TH ST
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City | CHICAGO
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State | IL
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Zip | 60617-6951
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | YAQIN DAWOUD
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Credential | DDS
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Telephone | 708-351-4562
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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 |
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License Number State |
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