Provider Demographics
NPI:1053847947
Name:O. EL HILLAL DMD, MS DENTAL CORP
Entity Type:Organization
Organization Name:O. EL HILLAL DMD, MS DENTAL CORP
Other - Org Name:ISMILES ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:OUSAMA
Authorized Official - Middle Name:
Authorized Official - Last Name:EL-HILLAL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:623-376-6464
Mailing Address - Street 1:8272 W LAKE PLEASANT PKWY STE 209
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-7432
Mailing Address - Country:US
Mailing Address - Phone:623-376-6464
Mailing Address - Fax:
Practice Address - Street 1:33 CREEK RD
Practice Address - Street 2:SUITE 280
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-4791
Practice Address - Country:US
Practice Address - Phone:949-551-4540
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS1008641223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty