Individual
AHMED MANSOUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2122 N MILWAUKEE AVE STE 1, CHICAGO, IL 60647-4251
(773) 227-1245
Mailing address
502 N ADDISON RD, VILLA PARK, IL 60181-1431
(630) 936-7997
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019032164
IL
Other
Enumeration date
07/23/2019
Last updated
07/23/2019
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