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General NPI Number Information
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NPI Number | 1174925895
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Entity Type | Organization
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Legal Business Name | M. ATTALLA DENTAL
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Dates
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Enumeration Date | 09/24/2014
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Last Update Date | 09/24/2014
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Provider Practice Location Address
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Address Line | 2117 E 71ST ST
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City | CHICAGO
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State | IL
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Zip | 60649-2103
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Country | US
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Telephone | 773-288-0225
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Fax | 773-288-0485
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Provider Business Mailing Address
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Address Line | PO BOX 497010
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City | CHICAGO
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State | IL
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Zip | 60649-0094
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Country | US
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Telephone | 773-288-0225
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Fax | 773-288-0485
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Authorized Official
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Title or Position | OWNER
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Name | DR. MAMDOUH M. ATTALLA
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Credential | DDS
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Telephone | 773-288-0225
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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 | 01902261
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License Number State | IL
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