Tesneim Awadallah, DMD

Individual provider Active NPI General Practice Dentistry · Burbank, IL

NPI 1558034116 · NPPES record last updated Jul 29, 2021

Key facts

NPI
1558034116
Entity type
Individual (NPI type 1)
Primary specialty
General Practice Dentistry 1223G0001X
License
019033351 (IL)
Practice address
5600 W 87TH St
Burbank, IL 60459-2902
Phone
(708) 952-0000
NPI assigned
Jul 29, 2021
Sex
Female
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
019033351ILMDGeneral Practice Dentistry

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 019033351 IL Yes

Addresses

Primary practice location

5600 W 87TH St
Burbank, IL 60459-2902

Mailing address

5600 W 87TH St
Burbank, IL 60459-2902
Phone (708) 952-0000

Other providers in Burbank, IL

All providers in Burbank, IL · General Practice Dentistry in Illinois

Sources for this page

Verify at the official NPI Registry.