Healthcare Provider Details

I. General information

NPI: 1811568512
Provider Name (Legal Business Name): EMAD FARD DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2021
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10713 W 159TH ST
ORLAND PARK IL
60467-4531
US

IV. Provider business mailing address

401 N WABASH AVE UNIT 70D
CHICAGO IL
60611-3910
US

V. Phone/Fax

Practice location:
  • Phone: 708-301-5000
  • Fax:
Mailing address:
  • Phone: 312-925-0384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number021.003426
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: