MEDICARE: DR. MOHAMMED SHAHER ISMAIL DDS

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	019034652	IL

General Provider Information

NPI Number	:	1659144632
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MOHAMMED SHAHER ISMAIL DDS

Provider Business Mailing Address
First Line	:	50 YORKTOWN SHOPPING CTR UNIT 303
Second Line	:
City	:	LOMBARD
State	:	IL
Zip	:	60148-5630
Country	:	US
Telephone Number	:	708-267-9299
Fax Number	:

Provider Business Practice Location Address
First Line	:	107 W LAKE ST
Second Line	:
City	:	BLOOMINGDALE
State	:	IL
Zip	:	60108-1027
Country	:	US
Telephone Number	:	630-349-2030
Fax Number	:

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

Provider Enumeration Date	:	11/01/2023
Last Update Date	:	11/17/2023

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