MEDICARE: DR. DENIZ ALI NAMIK DMD

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	122300000X	Dentist	019.036592	IL
2	122300000X	Dentist	DENT.DE.70102472	WA
3	390200000X	Student in an Organized Health Care Education/Training Program	DERE.RR.61657863	WA

General Provider Information

NPI Number	:	1619867173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DENIZ ALI NAMIK DMD

Provider Business Mailing Address
First Line	:	320 DIAMOND BACK WAY
Second Line	:
City	:	ALGONQUIN
State	:	IL
Zip	:	60102-5043
Country	:	US
Telephone Number	:	847-858-6406
Fax Number	:

Provider Business Practice Location Address
First Line	:	4001 N COOK ST
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99207-5879
Country	:	US
Telephone Number	:	509-326-4382
Fax Number	:

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

Provider Enumeration Date	:	07/07/2025
Last Update Date	:	03/05/2026

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