MEDICARE: TEETH MATTER ON KEDZIE P.C.

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

General Provider Information

NPI Number	:	1902370489
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEETH MATTER ON KEDZIE P.C.

Provider Business Mailing Address
First Line	:	6235 S KEDZIE AVE STE 201
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60629-3304
Country	:	US
Telephone Number	:	773-936-5786
Fax Number	:	312-896-5835

Provider Business Practice Location Address
First Line	:	6235 S KEDZIE AVE STE 201
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60629-3304
Country	:	US
Telephone Number	:	773-936-5786
Fax Number	:	312-896-5835

Authorized Official
Title or Position	:	DENTIST
Name	:	MOHAMMED SALIH
Credential	:	DDS
Telephone Number	:	773-936-5786

Provider Enumeration Date	:	01/17/2019
Last Update Date	:	01/17/2019

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