MEDICARE: DR. NAWAR ALNOMAN D.D.S.

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	019029860	IL
2	122300000X	Dentist	30083	TX

General Provider Information

NPI Number	:	1942617808
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NAWAR ALNOMAN D.D.S.

Provider Business Mailing Address
First Line	:	2851 S KING DR APT 1306
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-2937
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2851 S KING DR APT 1306
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-2937
Country	:	US
Telephone Number	:	847-809-3212
Fax Number	:

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

Provider Enumeration Date	:	07/11/2014
Last Update Date	:	07/11/2014

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