Provider Demographics
NPI:1174925895
Name:M. ATTALLA DENTAL
Entity type:Organization
Organization Name:M. ATTALLA DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAMDOUH
Authorized Official - Middle Name:M
Authorized Official - Last Name:ATTALLA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-288-0225
Mailing Address - Street 1:PO BOX 497010
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60649-0094
Mailing Address - Country:US
Mailing Address - Phone:773-288-0225
Mailing Address - Fax:773-288-0485
Practice Address - Street 1:2117 E 71ST ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60649-2103
Practice Address - Country:US
Practice Address - Phone:773-288-0225
Practice Address - Fax:773-288-0485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-24
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL01902261122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty