Provider Demographics
NPI:1982241147
Name:DENTAL IMPLANT & COSMETIC CENTER, INC
Entity Type:Organization
Organization Name:DENTAL IMPLANT & COSMETIC CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SANAA
Authorized Official - Middle Name:
Authorized Official - Last Name:DOWIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-867-8655
Mailing Address - Street 1:4740 N HARLEM AVE
Mailing Address - Street 2:
Mailing Address - City:HARWOOD HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60706-4607
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4740 N HARLEM AVE
Practice Address - Street 2:
Practice Address - City:HARWOOD HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60706-4607
Practice Address - Country:US
Practice Address - Phone:708-867-8655
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-06
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty