Provider Demographics
NPI:1780568238
Name:MAHMOUD, HODA (DMD)
Entity type:Individual
Prefix:DR
First Name:HODA
Middle Name:
Last Name:MAHMOUD
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7704 LECLAIRE AVE
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:IL
Mailing Address - Zip Code:60459-1542
Mailing Address - Country:US
Mailing Address - Phone:708-407-0405
Mailing Address - Fax:
Practice Address - Street 1:12200 WESTERN AVE STE 108
Practice Address - Street 2:
Practice Address - City:BLUE ISLAND
Practice Address - State:IL
Practice Address - Zip Code:60406-1493
Practice Address - Country:US
Practice Address - Phone:708-385-3700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-05
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190363941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice