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11316 W Wadsworth Rd Beach Park IL 60099-3367 | |
(847) 872-5530 | |
(847) 872-1683 |
Full Name | |
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Speciality | Dentist |
Location | 11316 W Wadsworth Rd, Beach Park, Illinois |
Authorized Official Name and Position | Tayseer Ahmed Ibrahim (PRESIDENT) |
Authorized Official Contact | 8478725530 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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11316 W Wadsworth Rd Beach Park IL 60099-3367 Ph: (847) 872-5530 | 11316 W Wadsworth Rd Beach Park IL 60099-3367 Ph: (847) 872-5530 |
NPI Number | 1235356635 |
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Provider Enumeration Date | 04/19/2007 |
Last Update Date | 01/22/2021 |
Identifier | Type | State | Issuer |
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1235356635 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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122300000X | Dentist | 01925457 (Illinois) | Primary |