Provider Demographics
NPI:1811155096
Name:KUTTAB, H JOHNNY IBRAHIM (DDS)
Entity type:Individual
Prefix:DR
First Name:H JOHNNY
Middle Name:IBRAHIM
Last Name:KUTTAB
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1090 KINGSDALE RD
Mailing Address - Street 2:
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-2377
Mailing Address - Country:US
Mailing Address - Phone:847-971-8847
Mailing Address - Fax:
Practice Address - Street 1:3012 W FULLERTON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-2808
Practice Address - Country:US
Practice Address - Phone:773-384-3500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-25
Last Update Date:2008-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190276401223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry