MEDICARE: CONFIDENTAL GROUP LLC

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
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1376044305
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONFIDENTAL GROUP LLC

Provider Business Mailing Address
First Line	:	7710 W NORTH AVE
Second Line	:
City	:	ELMWOOD PARK
State	:	IL
Zip	:	60707-4123
Country	:	US
Telephone Number	:	708-453-6677
Fax Number	:

Provider Business Practice Location Address
First Line	:	7710 W NORTH AVE
Second Line	:
City	:	ELMWOOD PARK
State	:	IL
Zip	:	60707-4123
Country	:	US
Telephone Number	:	708-453-6677
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	MUSTAFA OBAIDI
Credential	:	DMD
Telephone Number	:	708-453-6677

Provider Enumeration Date	:	02/25/2018
Last Update Date	:	02/25/2018

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Directions to “CONFIDENTAL GROUP LLC ” Practice Location

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