Provider Demographics
NPI:1437509270
Name:DOGWOOD GROUP PC
Entity Type:Organization
Organization Name:DOGWOOD GROUP PC
Other - Org Name:BERKELEY DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:L
Authorized Official - Last Name:GHONEIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-308-3787
Mailing Address - Street 1:1752 N TAFT AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:IL
Mailing Address - Zip Code:60163-1555
Mailing Address - Country:US
Mailing Address - Phone:773-308-3787
Mailing Address - Fax:
Practice Address - Street 1:1752 N TAFT AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:IL
Practice Address - Zip Code:60163-1555
Practice Address - Country:US
Practice Address - Phone:773-308-3787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-13
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019023860122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty