Provider Demographics
NPI:1639168024
Name:COMPLETE DENTAL CARE LTD
Entity Type:Organization
Organization Name:COMPLETE DENTAL CARE LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:YOUIL
Authorized Official - Middle Name:
Authorized Official - Last Name:MAMOOK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-267-2671
Mailing Address - Street 1:3205 W IRVING PARK RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-3301
Mailing Address - Country:US
Mailing Address - Phone:773-267-2671
Mailing Address - Fax:773-267-2628
Practice Address - Street 1:3205 W IRVING PARK RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-3301
Practice Address - Country:US
Practice Address - Phone:773-267-2671
Practice Address - Fax:773-267-2628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========OtherTAX ID NUMBER
IL=========OtherTAX ID NUMBER