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General NPI Number Information
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NPI Number | 1538304316
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Entity Type | Organization
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Legal Business Name | MIDWEST DENTAL SPECIALITIES
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Dates
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Enumeration Date | 12/09/2008
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Last Update Date | 12/09/2008
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Provider Practice Location Address
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Address Line | 7714 W 159TH ST
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City | ORLAND PARK
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State | IL
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Zip | 60462-5445
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Country | US
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Telephone | 708-429-2020
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Fax |
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Provider Business Mailing Address
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Address Line | 7714 W 159TH ST
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City | ORLAND PARK
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State | IL
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Zip | 60462-5445
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Country | US
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Telephone | 708-429-2020
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Fax |
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Authorized Official
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Title or Position | DOCTOR
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Name | NAJLA AHMAD AL-RAYYAN
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Credential | D.D.S
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Telephone | 708-599-4600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 019025223
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License Number State | IL
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