Provider Demographics
NPI:1144884834
Name:ALDELAYME, RAED (BDS)
Entity type:Individual
Prefix:
First Name:RAED
Middle Name:
Last Name:ALDELAYME
Suffix:
Gender:M
Credentials:BDS
Other - Prefix:
Other - First Name:RAED
Other - Middle Name:
Other - Last Name:ALDELAYME
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BDS
Mailing Address - Street 1:4501 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60609-3758
Mailing Address - Country:US
Mailing Address - Phone:773-548-0600
Mailing Address - Fax:339-161-0118
Practice Address - Street 1:2005 ROOSEVELT RD STE B
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-2746
Practice Address - Country:US
Practice Address - Phone:219-312-7639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-28
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.032011122300000X
MDLL8481223S0112X
IN12013939A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery