Provider Demographics
NPI:1679065791
Name:THE NILE FAMILY DENTAL INC
Entity Type:Organization
Organization Name:THE NILE FAMILY DENTAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:RIZKALLA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:347-977-3608
Mailing Address - Street 1:1111 S LAFLIN ST APT 1316
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-4661
Mailing Address - Country:US
Mailing Address - Phone:347-977-3608
Mailing Address - Fax:
Practice Address - Street 1:1111 S LAFLIN ST APT 1316
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-4661
Practice Address - Country:US
Practice Address - Phone:347-977-3608
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-04
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019031607261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental