MEDICARE: AHSAN AHMED D.D.S.M.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	019025114	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306837349
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AHSAN AHMED D.D.S.M.S.

Provider Business Mailing Address
First Line	:	32 SAINT GERMAIN PL
Second Line	:
City	:	ST CHARLES
State	:	IL
Zip	:	60175-4606
Country	:	US
Telephone Number	:	630-587-4470
Fax Number	:	630-513-1905

Provider Business Practice Location Address
First Line	:	32 SAINT GERMAIN PL
Second Line	:
City	:	ST CHARLES
State	:	IL
Zip	:	60175-4606
Country	:	US
Telephone Number	:	630-587-4470
Fax Number	:	630-513-1905

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/31/2005
Last Update Date	:	05/24/2011

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