Provider Demographics
NPI:1487826129
Name:DENTAL PRESTIGE LLC
Entity Type:Organization
Organization Name:DENTAL PRESTIGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KHALIL
Authorized Official - Middle Name:ADEL
Authorized Official - Last Name:ABUZIR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:708-424-5901
Mailing Address - Street 1:5501 W 79TH ST
Mailing Address - Street 2:SUITE #201
Mailing Address - City:BURBANK
Mailing Address - State:IL
Mailing Address - Zip Code:60459-1784
Mailing Address - Country:US
Mailing Address - Phone:708-424-5903
Mailing Address - Fax:
Practice Address - Street 1:5501 W 79TH ST
Practice Address - Street 2:SUITE #201
Practice Address - City:BURBANK
Practice Address - State:IL
Practice Address - Zip Code:60459-1784
Practice Address - Country:US
Practice Address - Phone:708-424-5903
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-01
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty