Provider Demographics
NPI:1437501301
Name:MAHMOOD, OLA R (DMD)
Entity Type:Individual
Prefix:DR
First Name:OLA
Middle Name:R
Last Name:MAHMOOD
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1298 S. MILWAUKEE AVE.
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048
Mailing Address - Country:US
Mailing Address - Phone:847-362-6540
Mailing Address - Fax:847-362-6544
Practice Address - Street 1:1298 S. MILWAUKEE AVE.
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048
Practice Address - Country:US
Practice Address - Phone:847-362-6540
Practice Address - Fax:847-362-6544
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-05
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1001386122300000X
IL019.030643122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist