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General NPI Number Information
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NPI Number | 1386719391
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Entity Type | Organization
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Legal Business Name | 1ST DENTAL CARE
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Dates
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Enumeration Date | 11/22/2006
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Last Update Date | 10/20/2014
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Provider Practice Location Address
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Address Line | 1556 DOUGLAS RD
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City | MONTGOMERY
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State | IL
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Zip | 60538-1645
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Country | US
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Telephone | 630-859-9340
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Fax | 630-859-9341
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Provider Business Mailing Address
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Address Line | 1556 DOUGLAS RD
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City | MONTGOMERY
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State | IL
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Zip | 60538-1645
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Country | US
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Telephone | 630-859-9340
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Fax | 630-859-9341
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Authorized Official
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Title or Position | DENTIST
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Name | ABDUL G MALAKI
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Credential | DDS
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Telephone | 630-859-9340
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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 | 019023856
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License Number State | IL
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