Healthcare Provider Details

I. General information

NPI: 1659144632
Provider Name (Legal Business Name): MOHAMMED SHAHER ISMAIL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2023
Last Update Date: 06/28/2026
Certification Date: 06/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

698 E BURRELL DR
CROWN POINT IN
46307-9000
US

IV. Provider business mailing address

61 SILO RIDGE RD S
ORLAND PARK IL
60467-7335
US

V. Phone/Fax

Practice location:
  • Phone: 219-662-7668
  • Fax:
Mailing address:
  • Phone: 708-267-9299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number12014954A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: