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NPI Code Detail

MEDICARE: HUSSAIN S ALI DDS LLC

MEDICARE: HUSSAIN S ALI DDS LLC
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
1122300000XDentist019029848IL

General Provider Information

NPI Number : 1780090878
Entity Type Code : Organization
Provider Name (Legal Business Name) : HUSSAIN S ALI DDS LLC
Provider Business Mailing Address
First Line : 4945 W GRAND AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60639-4412
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1726 W 18TH ST
Second Line :
City : CHICAGO
State : IL
Zip : 60608-3994
Country : US
Telephone Number : 312-733-7454
Fax Number :
Authorized Official
Title or Position : OWNER
Name : HUSSAIN ALI
Credential : DDS
Telephone Number : 224-366-0498
Provider Enumeration Date : 07/09/2014
Last Update Date : 07/09/2014

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Directions to “HUSSAIN S ALI DDS LLC ” Practice Location

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