Healthcare Provider Details

I. General information

NPI: 1659282903
Provider Name (Legal Business Name): MRA DENTAL SOLUTIONS P.L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 N STATE ROUTE 31 STE G
CRYSTAL LAKE IL
60012-3707
US

IV. Provider business mailing address

690 N STATE ROUTE 31 STE G
CRYSTAL LAKE IL
60012-3707
US

V. Phone/Fax

Practice location:
  • Phone: 815-477-2177
  • Fax: 815-477-8671
Mailing address:
  • Phone: 815-477-2177
  • Fax: 815-477-8671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. MOHAMMAD R AHMAD
Title or Position: OWNER, DENTIST
Credential: D.M.D.
Phone: 708-590-9424