Healthcare Provider Details

I. General information

NPI: 1477541811
Provider Name (Legal Business Name): FUWAD AL-SABEK DMD, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 11/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24228 W. LOCKPORT STREET SUITE :- 102
PLAINFIELD IL
60544
US

IV. Provider business mailing address

24228 W. LOCKPORT STREET SUITE:-102
PLAINFIELD IL
60544
US

V. Phone/Fax

Practice location:
  • Phone: 815-577-1883
  • Fax: 815-577-2010
Mailing address:
  • Phone: 815-577-1883
  • Fax: 815-577-2010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number019026438
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: