Provider Demographics
NPI:1710450952
Name:TEETH MATTER ON LAWRENCE P.C.
Entity Type:Organization
Organization Name:TEETH MATTER ON LAWRENCE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMED
Authorized Official - Middle Name:
Authorized Official - Last Name:SALIH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-936-5786
Mailing Address - Street 1:1658 N MILWAUKEE AVE STE 395
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-6905
Mailing Address - Country:US
Mailing Address - Phone:773-936-5786
Mailing Address - Fax:
Practice Address - Street 1:4408 W LAWRENCE AVE STE 201
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-2511
Practice Address - Country:US
Practice Address - Phone:773-936-5786
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-10
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty