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General NPI Number Information
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NPI Number | 1205703618
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Entity Type | Organization
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Legal Business Name | COSMO DENTAL
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Dates
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Enumeration Date | 10/21/2025
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Last Update Date | 10/21/2025
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Provider Practice Location Address
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Address Line | 159 E NORTH AVE
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City | NORTHLAKE
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State | IL
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Zip | 60164-2523
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Country | US
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Telephone | 708-345-6313
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Fax |
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Provider Business Mailing Address
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Address Line | 159 E NORTH AVE
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City | NORTHLAKE
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State | IL
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Zip | 60164-2523
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Country | US
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Telephone | 708-345-6313
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Fax |
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Authorized Official
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Title or Position | ASSOCIATE
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Name | DR. MOHAMMED ABDUL HAQ
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Credential | DDS
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Telephone | 847-262-1081
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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 |
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License Number State |
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Taxonomy #2
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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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