Organization
CHICAGO DENTAL COSMETICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MUSTAPHA A HOTAIT DDS (PRESIDENT)
(708) 849-4644
Entity
Organization
Contact information
Practice address
6338 S PULASKI RD, CHICAGO, IL 60629-4706
(708) 849-4644
Mailing address
6338 S PULASKI RD, CHICAGO, IL 60629-4706
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
019028105
IL
Other
Enumeration date
12/10/2012
Last updated
12/10/2012
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