Provider Demographics
NPI:1972155588
Name:ALSAKINI, MANAR
Entity Type:Individual
Prefix:
First Name:MANAR
Middle Name:
Last Name:ALSAKINI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7406 KEYSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-3927
Mailing Address - Country:US
Mailing Address - Phone:773-672-9215
Mailing Address - Fax:
Practice Address - Street 1:3074 W IL ROUTE 60 OFC
Practice Address - Street 2:
Practice Address - City:MUNDELEIN
Practice Address - State:IL
Practice Address - Zip Code:60060-4270
Practice Address - Country:US
Practice Address - Phone:847-970-7070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-13
Last Update Date:2019-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019032095122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist