Provider Demographics
NPI:1669761482
Name:MEDHAT DENTAL, LLC
Entity type:Organization
Organization Name:MEDHAT DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MEDHAT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-774-4711
Mailing Address - Street 1:6011 N MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-4709
Mailing Address - Country:US
Mailing Address - Phone:773-774-4711
Mailing Address - Fax:
Practice Address - Street 1:6011 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-4709
Practice Address - Country:US
Practice Address - Phone:773-774-4711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-01
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty