Healthcare Provider Details

I. General information

NPI: 1578496139
Provider Name (Legal Business Name): ADAM WAHBY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14955 S VAN DYKE RD UNIT 100
PLAINFIELD IL
60544-5807
US

IV. Provider business mailing address

3359 S HAMILTON AVE
CHICAGO IL
60608-6033
US

V. Phone/Fax

Practice location:
  • Phone: 815-436-4900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019.037144
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: