Provider Demographics
NPI:1114615499
Name:ABUHAMDA, DIMA (DDS)
Entity Type:Individual
Prefix:
First Name:DIMA
Middle Name:
Last Name:ABUHAMDA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15957 BLACKWATER CT
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-6759
Mailing Address - Country:US
Mailing Address - Phone:708-964-6692
Mailing Address - Fax:
Practice Address - Street 1:2901 PLAINFIELD RD # UNITEA
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-1121
Practice Address - Country:US
Practice Address - Phone:815-287-0649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-25
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL019.0346381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program