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General NPI Number Information
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NPI Number | 1356515175
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Entity Type | Organization
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Legal Business Name | MIDWEST DENTAL ASSOCIATES
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Dates
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Enumeration Date | 04/14/2008
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Last Update Date | 04/14/2008
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Provider Practice Location Address
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Address Line | 1677 MONTGOMERY RD
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City | AURORA
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State | IL
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Zip | 60504-8802
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Country | US
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Telephone | 630-499-9400
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Fax | 630-499-9494
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Provider Business Mailing Address
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Address Line | 1677 MONTGOMERY RD
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City | AURORA
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State | IL
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Zip | 60504-8802
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Country | US
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Telephone | 630-499-9400
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Fax | 630-499-9494
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Authorized Official
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Title or Position | DENTIST
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Name | MRS. MOHAMMED/ SAMAAN SALAMAH/ SAMY
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Credential | DDS
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Telephone | 630-499-9400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 019026586
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License Number State | IL
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