MEDICARE: DR. MAJED BA MATRAF BDS

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	122300000X	Dentist	019.032926	IL

General Provider Information

NPI Number	:	1457922890
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAJED BA MATRAF BDS

Provider Business Mailing Address
First Line	:	2759 W 55TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60632-2251
Country	:	US
Telephone Number	:	773-776-5277
Fax Number	:

Provider Business Practice Location Address
First Line	:	2759 W 55TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60632-2251
Country	:	US
Telephone Number	:	773-776-5277
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2021
Last Update Date	:	07/07/2021

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