Healthcare Provider Details

I. General information

NPI: 1164046819
Provider Name (Legal Business Name): JUWERIA AMJED DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2020
Last Update Date: 03/01/2022
Certification Date: 03/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4015 PLAINFIELD NAPERVILLE RD STE 106
NAPERVILLE IL
60564-4239
US

IV. Provider business mailing address

8114 WINTER CIR
DOWNERS GROVE IL
60516-4505
US

V. Phone/Fax

Practice location:
  • Phone: 630-326-7056
  • Fax:
Mailing address:
  • Phone: 630-501-5638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019032584
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: