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General NPI Number Information
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NPI Number | 1811155096
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Entity Type | Individual
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Provider Name | H JOHNNY IBRAHIM KUTTAB D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 05/25/2008
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Last Update Date | 05/25/2008
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Provider Practice Location Address
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Address Line | 3012 W FULLERTON AVE
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City | CHICAGO
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State | IL
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Zip | 60647-2808
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Country | US
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Telephone | 773-384-3500
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Fax |
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Provider Business Mailing Address
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Address Line | 1090 KINGSDALE RD
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City | HOFFMAN ESTATES
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State | IL
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Zip | 60169-2377
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Country | US
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Telephone | 847-971-8847
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 019027640
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License Number State | IL
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