Provider Demographics
NPI:1275197253
Name:HYDE PARK AMAZING DENTAL LLC
Entity Type:Organization
Organization Name:HYDE PARK AMAZING DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMAHA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:082-532-2897
Mailing Address - Street 1:5501 W 79TH ST STE 302
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:IL
Mailing Address - Zip Code:60459-2185
Mailing Address - Country:US
Mailing Address - Phone:708-394-5100
Mailing Address - Fax:708-907-3165
Practice Address - Street 1:1634 E 53RD ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615-4384
Practice Address - Country:US
Practice Address - Phone:773-966-6465
Practice Address - Fax:773-952-4683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-25
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty