Organization
FULLERTON DENTAL ISLAND LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WISAM MUSA DDS (OWNER)
(312) 709-1722
Entity
Organization
Contact information
Practice address
5205 W FULLERTON AVE, CHICAGO, IL 60639-1401
(312) 709-1722
Mailing address
5836 W 100TH PL, OAK LAWN, IL 60453-3774
(312) 709-1722
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
04/09/2024
Last updated
04/09/2024
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