Provider Demographics
NPI:1982069126
Name:MX DENTAL ASSOCIATES PC
Entity Type:Organization
Organization Name:MX DENTAL ASSOCIATES PC
Other - Org Name:ALSIP DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAZAR
Authorized Official - Middle Name:S
Authorized Official - Last Name:SHUAIPAJ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:708-489-6222
Mailing Address - Street 1:11808 S PULASKI RD
Mailing Address - Street 2:
Mailing Address - City:ALSIP
Mailing Address - State:IL
Mailing Address - Zip Code:60803-1608
Mailing Address - Country:US
Mailing Address - Phone:708-489-6222
Mailing Address - Fax:
Practice Address - Street 1:11808 S PULASKI RD
Practice Address - Street 2:
Practice Address - City:ALSIP
Practice Address - State:IL
Practice Address - Zip Code:60803-1608
Practice Address - Country:US
Practice Address - Phone:708-489-6222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-15
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
No122300000XDental ProvidersDentistGroup - Single Specialty