Provider Demographics
NPI:1215458468
Name:GHADIALI, ABDULKADER (DDS)
Entity type:Individual
Prefix:
First Name:ABDULKADER
Middle Name:
Last Name:GHADIALI
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 1:16523 106TH CT UNIT C2
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-4545
Mailing Address - Country:US
Mailing Address - Phone:708-942-8154
Mailing Address - Fax:708-551-0753
Practice Address - Street 1:16523 106TH CT UNIT C2
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-4545
Practice Address - Country:US
Practice Address - Phone:708-942-8154
Practice Address - Fax:708-551-0753
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-28
Last Update Date:2025-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1017071223S0112X
IL019.0312441223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery