Provider Demographics
NPI:1043475809
Name:MAHAIRI DENTAL CENTER
Entity Type:Organization
Organization Name:MAHAIRI DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMJAD
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHAIRI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-488-1909
Mailing Address - Street 1:15 N GENEVA ST
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60120
Mailing Address - Country:US
Mailing Address - Phone:847-488-1909
Mailing Address - Fax:847-488-1925
Practice Address - Street 1:15 N GENEVA ST
Practice Address - Street 2:MAHAIRI DENTAL CENTER
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60120
Practice Address - Country:US
Practice Address - Phone:847-488-1909
Practice Address - Fax:847-488-1925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-22
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty