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General NPI Number Information
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NPI Number | 1508146580
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Entity Type | Organization
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Legal Business Name | REEM OBAISI, DDS, PC
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Dates
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Enumeration Date | 08/23/2011
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Last Update Date | 08/23/2011
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Provider Practice Location Address
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Address Line | 1629 S PRAIRIE AVE UNIT 2307
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City | CHICAGO
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State | IL
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Zip | 60616-4403
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Country | US
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Telephone | 217-871-0411
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Fax |
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Provider Business Mailing Address
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Address Line | 1629 S PRAIRIE AVE UNIT 2307
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City | CHICAGO
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State | IL
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Zip | 60616-4403
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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 | PRESIDENT
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Name | REEM OBAISI
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Credential |
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Telephone | 217-871-0411
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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 | 019027619
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License Number State | IL
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