Provider Demographics
NPI:1699946913
Name:PINEWOOD DENTAL, PC
Entity type:Organization
Organization Name:PINEWOOD DENTAL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SAQIB
Authorized Official - Middle Name:H
Authorized Official - Last Name:MOHAJIR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:708-364-0641
Mailing Address - Street 1:11979 W 143RD ST
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-7218
Mailing Address - Country:US
Mailing Address - Phone:708-364-0641
Mailing Address - Fax:708-364-0657
Practice Address - Street 1:11979 W 143RD ST
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-7218
Practice Address - Country:US
Practice Address - Phone:708-364-0641
Practice Address - Fax:708-364-0657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty