Healthcare Provider Details

I. General information

NPI: 1144889783
Provider Name (Legal Business Name): FAKHRA AHMAD DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2019
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1863 HICKS RD
ROLLING MEADOWS IL
60008-1215
US

IV. Provider business mailing address

119 W NOYES ST
ARLINGTON HEIGHTS IL
60005-3747
US

V. Phone/Fax

Practice location:
  • Phone: 847-991-3009
  • Fax:
Mailing address:
  • Phone: 224-800-2955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number1002102
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: