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General NPI Number Information
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NPI Number | 1679439160
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Entity Type | Organization
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Legal Business Name | DES-WAY DENTAL GROUP PLLC
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Dates
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Enumeration Date | 12/29/2025
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Last Update Date | 12/30/2025
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Provider Practice Location Address
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Address Line | 18213 DIXIE HWY
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City | HOMEWOOD
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State | IL
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Zip | 60430-2205
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Country | US
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Telephone | 708-647-9112
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Fax |
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Provider Business Mailing Address
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Address Line | 18213 DIXIE HWY
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City | HOMEWOOD
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State | IL
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Zip | 60430-2205
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Country | US
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Telephone | 708-647-9112
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MOSTAFA IBRAHIM
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Credential | BDS,PROSTHDONTIST
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Telephone | 609-968-8353
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number |
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License Number State |
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