Healthcare Provider Details

I. General information

NPI: 1124931316
Provider Name (Legal Business Name): FNU MOHAMMED NOORUDDIN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MOHAMMED NOORUDDIN DDS

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3435 W IRVING PARK RD
CHICAGO IL
60618-3217
US

IV. Provider business mailing address

818 BISHOP CT
SCHAUMBURG IL
60194-2201
US

V. Phone/Fax

Practice location:
  • Phone: 773-588-8200
  • Fax:
Mailing address:
  • Phone: 224-623-3771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019.037434
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: