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General NPI Number Information
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NPI Number | 1720259831
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Entity Type | Organization
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Legal Business Name | OPTIMAL DENTAL PARTNERSHIP
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Dates
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Enumeration Date | 03/17/2008
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Last Update Date | 03/17/2008
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Provider Practice Location Address
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Address Line | 15916 HARLEM AVE
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City | TINLEY PARK
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State | IL
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Zip | 60477-1610
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Country | US
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Telephone | 708-802-6990
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Fax |
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Provider Business Mailing Address
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Address Line | 15916 HARLEM AVE
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City | TINLEY PARK
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State | IL
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Zip | 60477-1610
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Country | US
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Telephone | 708-802-6990
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. MOHAMMED RAHIMA
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Credential | DDS, MS, PHD
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Telephone | 708-802-6990
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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 |
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License Number State | IL
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