Provider Demographics
NPI:1871009738
Name:GENERAL DENTISTS LTD
Entity Type:Organization
Organization Name:GENERAL DENTISTS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:HOSSEIN
Authorized Official - Last Name:RANJBARI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:312-421-9500
Mailing Address - Street 1:1718 S ASHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-2015
Mailing Address - Country:US
Mailing Address - Phone:312-421-9500
Mailing Address - Fax:312-421-1321
Practice Address - Street 1:1718 S ASHLAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-2015
Practice Address - Country:US
Practice Address - Phone:312-421-9500
Practice Address - Fax:312-421-1321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-14
Last Update Date:2017-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019022116261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1851500078Medicaid