Provider Demographics
NPI:1396417580
Name:MY CARE DENTAL TINLEY PARK PLLC
Entity Type:Organization
Organization Name:MY CARE DENTAL TINLEY PARK PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:SHALASH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:917-993-2245
Mailing Address - Street 1:18311 N CREEK DR STE A
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-6204
Mailing Address - Country:US
Mailing Address - Phone:708-444-7288
Mailing Address - Fax:
Practice Address - Street 1:18311 N CREEK DR STE A
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-6204
Practice Address - Country:US
Practice Address - Phone:708-444-7288
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-05
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental