Healthcare Provider Details

I. General information

NPI: 1265368732
Provider Name (Legal Business Name): SYED MUBEEN MAHMOOD ALNOOR DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3024 S PARK AVE
HERRIN IL
62948-3721
US

IV. Provider business mailing address

1312 CHANCELLOR DR
EDWARDSVILLE IL
62025-3954
US

V. Phone/Fax

Practice location:
  • Phone: 618-727-7565
  • Fax:
Mailing address:
  • Phone: 214-843-6024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019.037209
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: