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General NPI Number Information
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NPI Number | 1861273047
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Entity Type | Organization
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Legal Business Name | MY DENTAL HOME LLC
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Dates
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Enumeration Date | 10/12/2023
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Last Update Date | 10/12/2023
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Provider Practice Location Address
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Address Line | 1700 RAVINIA PL
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City | ORLAND PARK
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State | IL
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Zip | 60462-3543
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Country | US
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Telephone | 708-696-1004
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Fax | 708-696-1045
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Provider Business Mailing Address
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Address Line | 1700 RAVINIA PL
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City | ORLAND PARK
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State | IL
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Zip | 60462-3543
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Country | US
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Telephone | 708-696-1004
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Fax | 708-696-1045
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | DR. BILAL ALNAHASS
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Credential | DMD
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Telephone | 331-201-7077
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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