Individual
MANSOUR MUSA MOHAMMED
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
16473 W 159TH ST, LOCKPORT, IL 60441-7961
(815) 221-4200
Mailing address
14512 ALBANY AVE, LEMONT, IL 60439-4000
(708) 369-7458
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019.035196
IL
Other
Enumeration date
06/08/2024
Last updated
06/08/2024
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