Provider Demographics
NPI:1669054375
Name:UNITED DENTAL GROUP PLLC
Entity type:Organization
Organization Name:UNITED DENTAL GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MUNIR
Authorized Official - Middle Name:
Authorized Official - Last Name:GOMAA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:847-620-9864
Mailing Address - Street 1:50 MARION LN
Mailing Address - Street 2:
Mailing Address - City:STREAMWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60107-6664
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:50 MARION LN
Practice Address - Street 2:
Practice Address - City:STREAMWOOD
Practice Address - State:IL
Practice Address - Zip Code:60107-6664
Practice Address - Country:US
Practice Address - Phone:847-620-9864
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-22
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty