Organization
GARDENIA DENTAL II LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MOHAMMAD KHAMIS MD (MANAGER)
(773) 353-5047
Entity
Organization
Contact information
Practice address
5352 N LINCOLN AVE, CHICAGO, IL 60625-2316
(773) 353-5047
(773) 303-6344
Mailing address
5352 N LINCOLN AVE, CHICAGO, IL 60625-2316
(773) 353-5047
(773) 303-6344
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
IL
Other
Enumeration date
10/18/2013
Last updated
10/18/2013
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