MEDICARE: NOOR AHMAD 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	019.035061	IL

General Provider Information

NPI Number	:	1972341543
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NOOR AHMAD DMD

Provider Business Mailing Address
First Line	:	3629 W 115TH PL
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60655-6203
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	25 E WASHINGTON ST STE 1921
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60602-1826
Country	:	US
Telephone Number	:	312-782-8862
Fax Number	:

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

Provider Enumeration Date	:	07/18/2024
Last Update Date	:	07/18/2024

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