Provider Demographics
NPI:1861560211
Name:HALIM, MIREILLE CAMILLE (DDS)
Entity type:Individual
Prefix:DR
First Name:MIREILLE
Middle Name:CAMILLE
Last Name:HALIM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8930 WAUKEGAN RD STE 110
Mailing Address - Street 2:
Mailing Address - City:MORTON GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60053-2116
Mailing Address - Country:US
Mailing Address - Phone:847-990-0897
Mailing Address - Fax:847-967-0400
Practice Address - Street 1:8930 WAUKEGAN RD STE 110
Practice Address - Street 2:
Practice Address - City:MORTON GROVE
Practice Address - State:IL
Practice Address - Zip Code:60053-2116
Practice Address - Country:US
Practice Address - Phone:847-990-0897
Practice Address - Fax:847-967-0400
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice