Provider Demographics
NPI:1164608592
Name:BURBANK DENTAL
Entity Type:Organization
Organization Name:BURBANK DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PERIODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NUHA
Authorized Official - Middle Name:
Authorized Official - Last Name:NAKIB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-432-6114
Mailing Address - Street 1:4817 W 83RD ST
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:IL
Mailing Address - Zip Code:60459-2790
Mailing Address - Country:US
Mailing Address - Phone:708-423-6114
Mailing Address - Fax:708-229-0716
Practice Address - Street 1:4817 W 83RD ST
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:IL
Practice Address - Zip Code:60459-2790
Practice Address - Country:US
Practice Address - Phone:708-423-6114
Practice Address - Fax:708-229-0716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-16
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty