Provider Demographics
NPI:1881795888
Name:JAWAD G GHANAYEM DDS LTD
Entity type:Organization
Organization Name:JAWAD G GHANAYEM DDS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAWAD
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:GHANAYEM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-620-4370
Mailing Address - Street 1:1 SO 132 SUMMIT AVE
Mailing Address - Street 2:STE 302
Mailing Address - City:OAKBROOK TERRACE
Mailing Address - State:IL
Mailing Address - Zip Code:60181
Mailing Address - Country:US
Mailing Address - Phone:630-620-4370
Mailing Address - Fax:630-620-4371
Practice Address - Street 1:1 SO 132 SUMMIT AVE
Practice Address - Street 2:STE 302
Practice Address - City:OAKBROOK TERRACE
Practice Address - State:IL
Practice Address - Zip Code:60181
Practice Address - Country:US
Practice Address - Phone:630-620-4370
Practice Address - Fax:630-620-4371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty