Provider Demographics
NPI:1699062059
Name:KANNOUT AND ARNOUS PARTNERSHIP
Entity type:Organization
Organization Name:KANNOUT AND ARNOUS PARTNERSHIP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:FAWAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:KANNOUT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-240-1984
Mailing Address - Street 1:4527 N PULASKI RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-4415
Mailing Address - Country:US
Mailing Address - Phone:630-240-1984
Mailing Address - Fax:
Practice Address - Street 1:4527 N PULASKI RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-4415
Practice Address - Country:US
Practice Address - Phone:630-240-1984
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-06
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19024870261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental