Healthcare Provider Details

I. General information

NPI: 1336060482
Provider Name (Legal Business Name): FARAH ALI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2442 SYCAMORE RD
DEKALB IL
60115-2050
US

IV. Provider business mailing address

23 COUR MARQUIS
PALOS HILLS IL
60465-2410
US

V. Phone/Fax

Practice location:
  • Phone: 815-748-2666
  • Fax:
Mailing address:
  • Phone: 872-212-1894
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019037341
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: