Provider Demographics
NPI:1104846609
Name:ABDULLAH, BASEM BRUCE (DDS)
Entity Type:Individual
Prefix:DR
First Name:BASEM
Middle Name:BRUCE
Last Name:ABDULLAH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 E 7TH ST
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-4614
Mailing Address - Country:US
Mailing Address - Phone:630-247-5303
Mailing Address - Fax:
Practice Address - Street 1:605 E ALGONQUIN RD
Practice Address - Street 2:SUITE 400
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-4373
Practice Address - Country:US
Practice Address - Phone:847-640-1122
Practice Address - Fax:847-640-1160
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0205791223G0001X
IL021014631223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No1223G0001XDental ProvidersDentistGeneral Practice