Healthcare Provider Details

I. General information

NPI: 1124937925
Provider Name (Legal Business Name): TANVEER & TARIQ LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2026
Last Update Date: 09/05/2026
Certification Date: 09/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19848 S LA GRANGE RD
MOKENA IL
60448-9339
US

IV. Provider business mailing address

19848 S LA GRANGE RD
MOKENA IL
60448-9339
US

V. Phone/Fax

Practice location:
  • Phone: 708-995-1859
  • Fax:
Mailing address:
  • Phone: 708-995-1859
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. IRUM TARIQ
Title or Position: DENTIST
Credential: DDS
Phone: 708-995-1859