Organization
ADVANCE DENTAL MAKEOVER PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WISAM R MOHAMMAD DDS (PRESIDENT)
(773) 604-5050
Entity
Organization
Contact information
Practice address
4707 N PULASKI RD, CHICAGO, IL 60630-4312
(773) 604-5050
(773) 604-5030
Mailing address
4707 N PULASKI RD, CHICAGO, IL 60630-4312
(773) 604-5050
(773) 604-5030
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
IL
Other
Enumeration date
07/19/2006
Last updated
08/22/2020
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