Provider Demographics
NPI:1427222645
Name:NIDA A. MAROUF, D.M.D., LTD.
Entity Type:Organization
Organization Name:NIDA A. MAROUF, D.M.D., LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NIDA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MAROUF
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:773-293-0606
Mailing Address - Street 1:2721 SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-1325
Mailing Address - Country:US
Mailing Address - Phone:847-681-2229
Mailing Address - Fax:
Practice Address - Street 1:5787 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-4722
Practice Address - Country:US
Practice Address - Phone:773-293-0606
Practice Address - Fax:773-751-5237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-18
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty