MEDICARE: MEDHAT DENTAL, 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	1223G0001X	General Practice Dentistry		IL

General Provider Information

NPI Number	:	1669761482
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDHAT DENTAL, LLC

Provider Business Mailing Address
First Line	:	6011 N MILWAUKEE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60646-4709
Country	:	US
Telephone Number	:	773-774-4711
Fax Number	:

Provider Business Practice Location Address
First Line	:	6011 N MILWAUKEE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60646-4709
Country	:	US
Telephone Number	:	773-774-4711
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	DR. RAMIN A MEDHAT
Credential	:	DDS
Telephone Number	:	773-774-4711

Provider Enumeration Date	:	04/01/2011
Last Update Date	:	04/01/2011

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Directions to “MEDHAT DENTAL, LLC ” Practice Location

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