MEDICARE: SOMAYEH JAHEDI 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	1223G0001X	General Practice Dentistry	019030329	IL

General Provider Information

NPI Number	:	1710354063
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOMAYEH JAHEDI DMD

Provider Business Mailing Address
First Line	:	1S045 SUMMIT AVE
Second Line	:
City	:	OAKBROOK TERRACE
State	:	IL
Zip	:	60181-3978
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1S045 SUMMIT AVE
Second Line	:
City	:	OAKBROOK TERRACE
State	:	IL
Zip	:	60181-3978
Country	:	US
Telephone Number	:	630-390-5296
Fax Number	:

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

Provider Enumeration Date	:	08/21/2015
Last Update Date	:	08/21/2015

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