Provider Demographics
NPI:1144387168
Name:MASHNOUK, BANA AHDAB (DDS)
Entity Type:Individual
Prefix:DR
First Name:BANA
Middle Name:AHDAB
Last Name:MASHNOUK
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 1:210 N CASS AV
Mailing Address - Street 2:# D
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559
Mailing Address - Country:US
Mailing Address - Phone:630-737-0791
Mailing Address - Fax:630-737-0799
Practice Address - Street 1:210 N CASS AV
Practice Address - Street 2:# D
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559
Practice Address - Country:US
Practice Address - Phone:630-737-0791
Practice Address - Fax:630-737-0799
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223G0001XDental ProvidersDentistGeneral Practice