Provider Demographics
NPI:1447868344
Name:SALEH HASSAN, LINA
Entity type:Individual
Prefix:
First Name:LINA
Middle Name:
Last Name:SALEH HASSAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2653 N BURLING ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-1513
Mailing Address - Country:US
Mailing Address - Phone:312-543-9705
Mailing Address - Fax:
Practice Address - Street 1:6560 W FULLERTON AVE STE T
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60707-3435
Practice Address - Country:US
Practice Address - Phone:773-385-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-16
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019032669122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist