Ehab Taher Awadi Ghandour, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

019030058 Issued in IL

Practice address

12200 Western Ave
Ste 108
Blue Island, IL 60406-1398

Phone

(708) 385-3700

NPI assigned

Aug 14, 2014

Last updated

Apr 27, 2015By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Dental Experts, LLC

  • General Practice Dentistry
  • Blue Island, IL
  • NPI 1154592145
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1407974400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1430092800000",
    "number": "1659770741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12200 WESTERN AVE",
            "address_2": "STE 108",
            "city": "BLUE ISLAND",
            "state": "IL",
            "postal_code": "604061398",
            "telephone_number": "708-385-3700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12200 WESTERN AVE",
            "address_2": "STE 108",
            "city": "BLUE ISLAND",
            "state": "IL",
            "postal_code": "604061398",
            "telephone_number": "708-385-3700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GHANDOUR",
        "first_name": "EHAB",
        "middle_name": "TAHER AWADI",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-08-14",
        "last_updated": "2015-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019030058",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mikhail Freidine, MD
• Eiman Yousif Gafour, O.D
• Joaquin Galvan, CRNA
• Karla Garner
• Geo Allen Shoes Inc (George Allen Shoes Inc)
• Nicholas J Gierman, ATC
• Charlotte Amanda Glispie, PHARMD
• Anthony Kelly Goldboss, MD
• Laurie Sue Gordon, DDS
• Randall Jay Gordon, MD

• Dentist in Blue Island, IL
• Providers in Blue Island, IL by specialty
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.