Provider Demographics
NPI:1417215484
Name:DENTAL MAGIC OF NILES
Entity Type:Organization
Organization Name:DENTAL MAGIC OF NILES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HICHAM
Authorized Official - Middle Name:K
Authorized Official - Last Name:RIBA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-360-1281
Mailing Address - Street 1:5622 W TOUHY AVE
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-4001
Mailing Address - Country:US
Mailing Address - Phone:773-360-1281
Mailing Address - Fax:773-360-1285
Practice Address - Street 1:5622 W TOUHY AVE
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-4001
Practice Address - Country:US
Practice Address - Phone:773-360-1281
Practice Address - Fax:773-360-1285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-27
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190243731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty