Provider Demographics
NPI:1508146580
Name:REEM OBAISI, DDS, PC
Entity Type:Organization
Organization Name:REEM OBAISI, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:REEM
Authorized Official - Middle Name:
Authorized Official - Last Name:OBAISI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-871-0411
Mailing Address - Street 1:1629 S PRAIRIE AVE
Mailing Address - Street 2:UNIT 2307
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-4403
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1629 S PRAIRIE AVE
Practice Address - Street 2:UNIT 2307
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-4403
Practice Address - Country:US
Practice Address - Phone:217-871-0411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-23
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190276191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty