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NPI Code Detail

MEDICARE: LOOP DENTAL & SPA

MEDICARE: LOOP DENTAL & SPA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist

General Provider Information

NPI Number : 1013269505
Entity Type Code : Organization
Provider Name (Legal Business Name) : LOOP DENTAL & SPA
Provider Business Mailing Address
First Line : 1605 S MICHIGAN AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60616-1209
Country : US
Telephone Number : 312-360-1010
Fax Number : 312-496-3546
Provider Business Practice Location Address
First Line : 1605 S MICHIGAN AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60616-1209
Country : US
Telephone Number : 312-360-1010
Fax Number : 312-496-3546
Authorized Official
Title or Position : DENTIST/OWNER
Name : AHMED RAMAHA
Credential : DDS
Telephone Number : 312-360-1010
Provider Enumeration Date : 10/08/2012
Last Update Date : 10/08/2012

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Directions to “LOOP DENTAL & SPA ” Practice Location

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