Provider Demographics
NPI:1245482025
Name:ABUGHAZALEH INC.
Entity type:Organization
Organization Name:ABUGHAZALEH INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KHALED
Authorized Official - Middle Name:
Authorized Official - Last Name:ABUGHAZALEH
Authorized Official - Suffix:
Authorized Official - Credentials:BDS,DMD
Authorized Official - Phone:312-498-1588
Mailing Address - Street 1:65 E SCOTT ST APT 9A
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-5274
Mailing Address - Country:US
Mailing Address - Phone:312-498-1588
Mailing Address - Fax:
Practice Address - Street 1:65 E SCOTT ST APT 9A
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-5274
Practice Address - Country:US
Practice Address - Phone:312-498-1588
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-11
Last Update Date:2008-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190240341223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty