Healthcare Provider Details

I. General information

NPI: 1417392457
Provider Name (Legal Business Name): NOOR AMINAH OBAISI D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2013
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1208 LAURA LN
WOODRIDGE IL
60517-5062
US

IV. Provider business mailing address

1208 LAURA LN
WOODRIDGE IL
60517-5062
US

V. Phone/Fax

Practice location:
  • Phone: 217-314-0033
  • Fax:
Mailing address:
  • Phone: 217-314-0033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number019028304
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number021002568
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: