Provider Demographics
NPI:1558986547
Name:TLEMAT, NADAH (DDS)
Entity Type:Individual
Prefix:
First Name:NADAH
Middle Name:
Last Name:TLEMAT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1617 MOUNTAIN RIDGE PASS
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60586-2772
Mailing Address - Country:US
Mailing Address - Phone:815-630-9300
Mailing Address - Fax:
Practice Address - Street 1:519 N PLUM ST
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:IL
Practice Address - Zip Code:61764-1818
Practice Address - Country:US
Practice Address - Phone:815-844-6184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-15
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0326881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice