Provider Demographics
NPI:1275077471
Name:DR. RAMY BAHU, DDS AESTHETIC & RECONSTRUCTIVE DENTAL ASSOCIATES
Entity Type:Organization
Organization Name:DR. RAMY BAHU, DDS AESTHETIC & RECONSTRUCTIVE DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAMY
Authorized Official - Middle Name:
Authorized Official - Last Name:BAHU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:312-943-6444
Mailing Address - Street 1:845 N MICHIGAN AVE
Mailing Address - Street 2:SUITE 948W
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2252
Mailing Address - Country:US
Mailing Address - Phone:312-943-6444
Mailing Address - Fax:312-943-6432
Practice Address - Street 1:845 N MICHIGAN AVE
Practice Address - Street 2:SUITE 948W
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2252
Practice Address - Country:US
Practice Address - Phone:312-943-6444
Practice Address - Fax:312-943-6432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-07
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILBB3473636122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty