Provider Demographics
NPI:1568836617
Name:INTERNATIONAL DENTAL OF BRIDGEVIEW LLC
Entity Type:Organization
Organization Name:INTERNATIONAL DENTAL OF BRIDGEVIEW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SALEH
Authorized Official - Middle Name:
Authorized Official - Last Name:AKHRAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:708-261-0861
Mailing Address - Street 1:7124 W 83RD ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:BRIDGEVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60455-4034
Mailing Address - Country:US
Mailing Address - Phone:708-261-0861
Mailing Address - Fax:
Practice Address - Street 1:7124 W 83RD ST
Practice Address - Street 2:SUITE E
Practice Address - City:BRIDGEVIEW
Practice Address - State:IL
Practice Address - Zip Code:60455-4034
Practice Address - Country:US
Practice Address - Phone:708-261-0861
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-29
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental