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General NPI Number Information
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NPI Number | 1730738121
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Entity Type | Organization
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Legal Business Name | BRIDGEVIEW SMILES
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Dates
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Enumeration Date | 09/09/2019
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Last Update Date | 09/09/2019
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Provider Practice Location Address
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Address Line | 8729 S HARLEM AVE
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City | BRIDGEVIEW
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State | IL
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Zip | 60455-1905
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Country | US
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Telephone | 708-930-5134
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Fax |
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Provider Business Mailing Address
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Address Line | 8729 S HARLEM AVE
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City | BRIDGEVIEW
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State | IL
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Zip | 60455-1905
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Country | US
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Telephone | 708-930-5134
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Fax |
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Authorized Official
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Title or Position | DR
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Name | MAGDI IBRAHIM
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Credential | DMD
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Telephone | 708-415-8943
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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 |
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License Number State |
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