Provider Demographics
NPI:1750105748
Name:ILLINOIS ORAL SURGERY & IMPLANT CENTER OF CHANNAHON
Entity type:Organization
Organization Name:ILLINOIS ORAL SURGERY & IMPLANT CENTER OF CHANNAHON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMED
Authorized Official - Middle Name:K
Authorized Official - Last Name:ALMANDALAWI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, BDS
Authorized Official - Phone:630-355-9449
Mailing Address - Street 1:27025 W EAMES ST
Mailing Address - Street 2:
Mailing Address - City:CHANNAHON
Mailing Address - State:IL
Mailing Address - Zip Code:60410-5619
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:27025 W EAMES ST
Practice Address - Street 2:
Practice Address - City:CHANNAHON
Practice Address - State:IL
Practice Address - Zip Code:60410-5619
Practice Address - Country:US
Practice Address - Phone:630-355-9449
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-14
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery