Provider Demographics
NPI:1689839714
Name:MICHAEL, MAGDY HM (DDS)
Entity Type:Individual
Prefix:DR
First Name:MAGDY
Middle Name:HM
Last Name:MICHAEL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5980 ROUTE 53 STE E
Mailing Address - Street 2:
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-3389
Mailing Address - Country:US
Mailing Address - Phone:630-322-8202
Mailing Address - Fax:630-322-9355
Practice Address - Street 1:5980 ROUTE 53 STE E
Practice Address - Street 2:
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-3389
Practice Address - Country:US
Practice Address - Phone:630-322-8202
Practice Address - Fax:630-322-9355
Is Sole Proprietor?:No
Enumeration Date:2008-07-29
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190222681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice