Provider Demographics
NPI:1124027990
Name:NAGUIB, GAMAL S (DMD)
Entity Type:Individual
Prefix:
First Name:GAMAL
Middle Name:S
Last Name:NAGUIB
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8135 N MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-2828
Mailing Address - Country:US
Mailing Address - Phone:847-967-8098
Mailing Address - Fax:847-967-8594
Practice Address - Street 1:302 E SAINT CHARLES RD
Practice Address - Street 2:
Practice Address - City:VILLA PARK
Practice Address - State:IL
Practice Address - Zip Code:60181-2420
Practice Address - Country:US
Practice Address - Phone:630-936-4410
Practice Address - Fax:630-563-9174
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-14
Last Update Date:2022-07-21
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-03-24
Provider Licenses
StateLicense IDTaxonomies
IL019014756204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL33060OtherBLUE SHIELD OF ILLINOIS
IL019014756Medicaid
ILK44936Medicare PIN
IL33060OtherBLUE SHIELD OF ILLINOIS