Provider Demographics
NPI:1881424034
Name:FAMILY DENTAL OF PARK RIDGE PLLC
Entity type:Organization
Organization Name:FAMILY DENTAL OF PARK RIDGE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NIDAL
Authorized Official - Middle Name:
Authorized Official - Last Name:OBEID
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-679-2421
Mailing Address - Street 1:2817 CENTRAL RD
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-4129
Mailing Address - Country:US
Mailing Address - Phone:773-679-2419
Mailing Address - Fax:
Practice Address - Street 1:5399 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-1251
Practice Address - Country:US
Practice Address - Phone:773-763-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-02
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental