Provider Demographics
NPI:1275638991
Name:DABHI, JOSEPHINE J (DDS DENTIST)
Entity Type:Individual
Prefix:MRS
First Name:JOSEPHINE
Middle Name:J
Last Name:DABHI
Suffix:
Gender:F
Credentials:DDS DENTIST
Other - Prefix:MRS
Other - First Name:JOSEPHINA
Other - Middle Name:J
Other - Last Name:DABHI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1105 W PARK AVE SUITE 8
Mailing Address - Street 2:PARK DENTAL
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048
Mailing Address - Country:US
Mailing Address - Phone:847-362-4740
Mailing Address - Fax:847-362-4764
Practice Address - Street 1:1105 W PARK AVE SUITE 8
Practice Address - Street 2:PARK DENTAL
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048
Practice Address - Country:US
Practice Address - Phone:847-362-4740
Practice Address - Fax:847-362-4764
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190244621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL019024462OtherLICENSE #
319013054OtherCONTROL SUBSTANCE LICENSE