Individual
MAHMOUD JALLAD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS, MSD
Contact information
Practice address
3024 S PARK AVE, HERRIN, IL 62948-3721
(833) 337-9563
Mailing address
3205 ARABIAN CT, HERRIN, IL 62948-3788
(334) 354-7852
(334) 354-7852
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019.029749
IL
Other
Enumeration date
08/14/2014
Last updated
09/05/2022
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