Healthcare Provider Details

I. General information

NPI: 1528848066
Provider Name (Legal Business Name): DR. ABDULLAH ABD ESSAMAD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ABDULLAH SAMAD D.D.S.

II. Dates (important events)

Enumeration Date: 10/02/2023
Last Update Date: 07/18/2026
Certification Date: 07/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 E BENTON PL STE 202
CHICAGO IL
60601-7411
US

IV. Provider business mailing address

400 E RANDOLPH ST APT 1015
CHICAGO IL
60601-7430
US

V. Phone/Fax

Practice location:
  • Phone: 312-868-0301
  • Fax:
Mailing address:
  • Phone: 708-227-5007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019.037311
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: