Provider Demographics
NPI:1861772394
Name:HYDE PARK UNIVERSAL DENTAL LLC
Entity type:Organization
Organization Name:HYDE PARK UNIVERSAL DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDEN
Authorized Official - Prefix:DR
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMAHA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-891-4209
Mailing Address - Street 1:9618 SOUTHWEST HWY
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2862
Mailing Address - Country:US
Mailing Address - Phone:708-394-5100
Mailing Address - Fax:708-907-3165
Practice Address - Street 1:1634 E 53RD ST
Practice Address - Street 2:SUITE 101
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615-4384
Practice Address - Country:US
Practice Address - Phone:773-966-6465
Practice Address - Fax:773-952-4683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-29
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty