Organization
BERWYN DENTAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
YAQIN DAWOUD DDS (OWNER)
(708) 351-4562
Entity
Organization
Contact information
Practice address
6436 CERMAK RD, BERWYN, IL 60402-2310
(708) 317-5264
(708) 317-5271
Mailing address
1600 E 93RD ST, CHICAGO, IL 60617-3607
(708) 351-4562
(773) 530-7550
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1487110029
NPI
IL
01
—
1972922102
NPI
IL
Enumeration date
08/10/2022
Last updated
08/22/2022
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