Provider Demographics
NPI:1477062701
Name:NEW FAMILY DENTAL
Entity Type:Organization
Organization Name:NEW FAMILY DENTAL
Other - Org Name:NEW FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:
Authorized Official - First Name:AMJAD
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHAIRI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-488-1909
Mailing Address - Street 1:1768 W ALGONQUIN RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-3405
Mailing Address - Country:US
Mailing Address - Phone:331-234-3000
Mailing Address - Fax:
Practice Address - Street 1:1768 W ALGONQUN RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005
Practice Address - Country:US
Practice Address - Phone:331-234-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1194784470Medicaid