Provider Demographics
NPI:1861273047
Name:MY DENTAL HOME LLC
Entity type:Organization
Organization Name:MY DENTAL HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:BILAL
Authorized Official - Middle Name:
Authorized Official - Last Name:ALNAHASS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:331-201-7077
Mailing Address - Street 1:1700 RAVINIA PL
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-3543
Mailing Address - Country:US
Mailing Address - Phone:708-696-1004
Mailing Address - Fax:708-696-1045
Practice Address - Street 1:1700 RAVINIA PL
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-3543
Practice Address - Country:US
Practice Address - Phone:708-696-1004
Practice Address - Fax:708-696-1045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-12
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental