Provider Demographics
NPI:1417239401
Name:MISWAK DENTISTRY INC
Entity Type:Organization
Organization Name:MISWAK DENTISTRY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TARIQ
Authorized Official - Middle Name:
Authorized Official - Last Name:RIYAL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-863-8342
Mailing Address - Street 1:201 HAMPSHIRE CT
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60565-3289
Mailing Address - Country:US
Mailing Address - Phone:630-863-8342
Mailing Address - Fax:
Practice Address - Street 1:201 HAMPSHIRE CT
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60565-3289
Practice Address - Country:US
Practice Address - Phone:630-863-8342
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190286011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1083907828Medicaid