Provider Demographics
NPI:1811559859
Name:AL-RAYESS, TAMARA (DMD)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:AL-RAYESS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6315 N MILWAUKEE AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-3761
Mailing Address - Country:US
Mailing Address - Phone:857-330-0517
Mailing Address - Fax:
Practice Address - Street 1:6315 N MILWAUKEE AVE STE 2
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-3761
Practice Address - Country:US
Practice Address - Phone:857-330-0517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-30
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0343981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice