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General NPI Number Information
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NPI Number | 1750694824
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Entity Type | Organization
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Legal Business Name | INTERNATIONAL DENTAL CENTER
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Dates
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Enumeration Date | 07/19/2010
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Last Update Date | 07/19/2010
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Provider Practice Location Address
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Address Line | 18 S LARKIN AVE UNIT 6
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City | JOLIET
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State | IL
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Zip | 60436-1244
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Country | US
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Telephone | 815-730-1570
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Fax |
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Provider Business Mailing Address
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Address Line | 18 S LARKIN AVE UNIT 6
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City | JOLIET
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State | IL
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Zip | 60436-1244
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Country | US
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Telephone | 815-730-1570
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. RABEH SALAMAH
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Credential | D.D.S
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Telephone | 773-865-2859
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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 | 019023066
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License Number State | IL
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