Healthcare Provider Details

I. General information

NPI: 1881087021
Provider Name (Legal Business Name): M. AL ASADI DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2015
Last Update Date: 03/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 CHICAGO RD
CHICAGO HEIGHTS IL
60411-4160
US

IV. Provider business mailing address

2400 CHICAGO RD
CHICAGO HEIGHTS IL
60411-4160
US

V. Phone/Fax

Practice location:
  • Phone: 708-755-2400
  • Fax: 708-755-2437
Mailing address:
  • Phone: 708-755-2400
  • Fax: 708-755-2437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019025105
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number019025105
License Number StateIL

VIII. Authorized Official

Name: DR. MOHAMMAD AL-ASADI
Title or Position: PRESIDENT
Credential: DDS
Phone: 708-755-2400