Provider Demographics
NPI:1912248162
Name:HYDE PARK UNIVERSAL DENTAL LLC
Entity Type:Organization
Organization Name:HYDE PARK UNIVERSAL DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMAHA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-966-6465
Mailing Address - Street 1:1634 E 53RD ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-4384
Mailing Address - Country:US
Mailing Address - Phone:773-966-6465
Mailing Address - Fax:773-952-4683
Practice Address - Street 1:1634 E 53RD ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615-4384
Practice Address - Country:US
Practice Address - Phone:773-966-6465
Practice Address - Fax:773-952-4683
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RAMAHA DENTAL PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-03-13
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty