Provider Demographics
NPI:1124278734
Name:STONE PARK DENTAL INC
Entity type:Organization
Organization Name:STONE PARK DENTAL INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMAHA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:708-338-4444
Mailing Address - Street 1:1550 N MANNHEIM RD
Mailing Address - Street 2:
Mailing Address - City:STONE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60165-1300
Mailing Address - Country:US
Mailing Address - Phone:708-338-4444
Mailing Address - Fax:708-338-4448
Practice Address - Street 1:1550 N MANNHEIM RD
Practice Address - Street 2:
Practice Address - City:STONE PARK
Practice Address - State:IL
Practice Address - Zip Code:60165-1300
Practice Address - Country:US
Practice Address - Phone:708-338-4444
Practice Address - Fax:708-338-4448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-19
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190276441223G0001X
IL0190270351223G0001X
IL0190270511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty