MEDICARE: M. AL ASADI DDS PC

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	261QD0000X	Dental Clinic/Center	019025105	IL
2	1223G0001X	General Practice Dentistry	019025105	IL

General Provider Information

NPI Number	:	1881087021
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	M. AL ASADI DDS PC

Provider Business Mailing Address
First Line	:	2400 CHICAGO RD
Second Line	:
City	:	CHICAGO HEIGHTS
State	:	IL
Zip	:	60411-4160
Country	:	US
Telephone Number	:	708-755-2400
Fax Number	:	708-755-2437

Provider Business Practice Location Address
First Line	:	2400 CHICAGO RD
Second Line	:
City	:	CHICAGO HEIGHTS
State	:	IL
Zip	:	60411-4160
Country	:	US
Telephone Number	:	708-755-2400
Fax Number	:	708-755-2437

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MOHAMMAD AL-ASADI
Credential	:	DDS
Telephone Number	:	708-755-2400

Provider Enumeration Date	:	03/12/2015
Last Update Date	:	03/12/2015

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