Provider Demographics
NPI:1508102021
Name:TARABISHY, KENAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:KENAN
Middle Name:
Last Name:TARABISHY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1199 E PORT CLINTON RD
Mailing Address - Street 2:UNIT 308
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-1249
Mailing Address - Country:US
Mailing Address - Phone:352-585-7336
Mailing Address - Fax:
Practice Address - Street 1:5151 MOCHEL DR
Practice Address - Street 2:SUITE 300
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-5076
Practice Address - Country:US
Practice Address - Phone:630-796-0700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-02
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019028915122300000X
WI694415122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist