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General NPI Number Information
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NPI Number | 1841105996
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Entity Type | Individual
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Provider Name | IBTISAM ABDALLAH DMD
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Gender | Female
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Dates
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Enumeration Date | 08/14/2026
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Last Update Date | 08/14/2026
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Provider Practice Location Address
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Address Line | 7895 W 159TH ST
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City | TINLEY PARK
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State | IL
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Zip | 60477-1343
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Country | US
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Telephone | 708-429-4822
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Fax |
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Provider Business Mailing Address
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Address Line | 5 SILO RIDGE RD S
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City | ORLAND PARK
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State | IL
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Zip | 60467-7333
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Country | US
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Telephone |
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019037444
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License Number State | IL
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