Provider Demographics
NPI:1356045264
Name:CHICAGO DENTISTRY LLC
Entity type:Organization
Organization Name:CHICAGO DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:HAMZA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHAMMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-247-7216
Mailing Address - Street 1:1568 W OGDEN AVE STE 108
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-4090
Mailing Address - Country:US
Mailing Address - Phone:630-247-7216
Mailing Address - Fax:
Practice Address - Street 1:654 E 47TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60653-4224
Practice Address - Country:US
Practice Address - Phone:773-624-5800
Practice Address - Fax:773-787-2400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty