Provider Demographics
NPI:1124170535
Name:MAJZOUB, ABDUL (DDS)
Entity type:Individual
Prefix:DR
First Name:ABDUL
Middle Name:
Last Name:MAJZOUB
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4724 N KEDZIE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-4421
Mailing Address - Country:US
Mailing Address - Phone:773-583-4455
Mailing Address - Fax:773-583-8986
Practice Address - Street 1:4724 N KEDZIE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-4421
Practice Address - Country:US
Practice Address - Phone:773-583-4455
Practice Address - Fax:773-583-8986
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice