Provider Demographics
NPI:1407569247
Name:AMANA FAMILY DENTAL PC
Entity Type:Organization
Organization Name:AMANA FAMILY DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:
Authorized Official - First Name:HICHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:RIBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-981-3433
Mailing Address - Street 1:9544 W 147TH ST
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-2502
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9544 W 147TH ST
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-2502
Practice Address - Country:US
Practice Address - Phone:708-981-3433
Practice Address - Fax:708-966-0082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-26
Last Update Date:2022-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty