Individual
MUSTAFA SIDDIQ ALI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
4630 S BISHOP ST, CHICAGO, IL 60609-3240
(773) 523-2615
Mailing address
4630 S BISHOP ST, CHICAGO, IL 60609-3240
(773) 523-2615
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019.033703
IL
Other
Enumeration date
06/16/2022
Last updated
06/16/2022
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