Individual
KHALED BASSAM BISHAWI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
61 W 144TH ST, RIVERDALE, IL 60827-2850
(708) 849-8627
Mailing address
9759 RIDGELAND AVE APT 2E, OAK LAWN, IL 60453-2790
(708) 374-2034
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019.035107
IL
Other
Enumeration date
05/30/2024
Last updated
05/30/2024
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