Provider Demographics
NPI:1760563761
Name:MIDWEST DENTAL CENTER
Entity Type:Organization
Organization Name:MIDWEST DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:NAJLA
Authorized Official - Middle Name:AHMAD
Authorized Official - Last Name:AL-RAYYAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:708-599-4600
Mailing Address - Street 1:7374 W.87TH ST.
Mailing Address - Street 2:
Mailing Address - City:BRIDGEVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60455
Mailing Address - Country:US
Mailing Address - Phone:708-599-4600
Mailing Address - Fax:708-599-6105
Practice Address - Street 1:7374 W 87TH ST
Practice Address - Street 2:
Practice Address - City:BRIDGEVIEW
Practice Address - State:IL
Practice Address - Zip Code:60455-1824
Practice Address - Country:US
Practice Address - Phone:708-599-4600
Practice Address - Fax:708-599-6105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty