Provider Demographics
NPI:1134386022
Name:OSAMA ISMAIL D.D.S.
Entity type:Organization
Organization Name:OSAMA ISMAIL D.D.S.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:OSAMA
Authorized Official - Middle Name:
Authorized Official - Last Name:ISMAIL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-529-5559
Mailing Address - Street 1:2184 BLOOMINGDALE RD STE B
Mailing Address - Street 2:
Mailing Address - City:GLENDALE HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60139-1601
Mailing Address - Country:US
Mailing Address - Phone:630-529-5559
Mailing Address - Fax:630-529-5742
Practice Address - Street 1:2184 BLOOMINGDALE RD STE B
Practice Address - Street 2:
Practice Address - City:GLENDALE HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60139-1601
Practice Address - Country:US
Practice Address - Phone:630-529-5559
Practice Address - Fax:630-529-5742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0218341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty