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General NPI Number Information
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NPI Number | 1790327336
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Entity Type | Individual
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Provider Name | ABDULA ELKHADRA DMD
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Gender | Male
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Dates
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Enumeration Date | 10/15/2019
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Last Update Date | 09/23/2020
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Provider Practice Location Address
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Address Line | 4849 W BELMONT AVE
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City | CHICAGO
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State | IL
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Zip | 60641-4330
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Country | US
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Telephone | 773-930-4943
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Fax |
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Provider Business Mailing Address
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Address Line | 8691 CROWN CT
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City | BURR RIDGE
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State | IL
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Zip | 60527-7130
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Country | US
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Telephone | 630-880-6071
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 12013271A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 1002223-15
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019.032394
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License Number State | IL
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