Individual
DR. OMAR MOUKADDEM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
200 W LAKE ST, ADDISON, IL 60101-2513
(630) 628-3115
Mailing address
200 W LAKE ST, ADDISON, IL 60101-2513
(630) 628-3115
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019.033148
IL
Other
Enumeration date
06/21/2021
Last updated
06/21/2021
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