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NPI Code Detail

MEDICARE: INTERNATIONAL DENTAL CENTER

MEDICARE: INTERNATIONAL DENTAL CENTER
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
1305S00000XPoint of ServiceIL

General Provider Information

NPI Number : 1659427425
Entity Type Code : Organization
Provider Name (Legal Business Name) : INTERNATIONAL DENTAL CENTER
Provider Business Mailing Address
First Line : 3138 N NARRAGANSETT AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60634-4919
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3138 N NARRAGANSETT AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60634-4919
Country : US
Telephone Number : 773-227-1245
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : RABEH SALAMAH-MOHAMMAD
Credential :
Telephone Number : 773-227-1245
Provider Enumeration Date : 01/26/2007
Last Update Date : 07/21/2022

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Directions to “INTERNATIONAL DENTAL CENTER ” Practice Location

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