Provider Demographics
NPI:1457922890
Name:BA MATRAF, MAJED (BDS)
Entity Type:Individual
Prefix:DR
First Name:MAJED
Middle Name:
Last Name:BA MATRAF
Suffix:
Gender:M
Credentials:BDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2759 W 55TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60632-2251
Mailing Address - Country:US
Mailing Address - Phone:773-776-5277
Mailing Address - Fax:
Practice Address - Street 1:2759 W 55TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60632-2251
Practice Address - Country:US
Practice Address - Phone:773-776-5277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-07
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.032926122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist