Organization
CHICAGO ORAL MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BASSAM ALI ISSA DDS (PRESEIDENT)
(517) 214-4034
Entity
Organization
Contact information
Practice address
10763 163RD PLACE, ORLAND PARK, IL 60467
(517) 214-4034
Mailing address
10763 163RD PL, ORLAND PARK, IL 60467-8861
(517) 214-4034
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019029193
IL
Other
Enumeration date
12/26/2012
Last updated
12/26/2012
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