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General NPI Number Information
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NPI Number | 1043209257
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Entity Type | Organization
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Legal Business Name | TAYSEER A IBRAHIM DDS PC
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Dates
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Enumeration Date | 10/19/2005
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 11316 W WADSWORTH RD STE 101
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City | BEACH PARK
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State | IL
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Zip | 60099-3367
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Country | US
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Telephone | 847-872-5530
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Fax | 847-872-1683
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Provider Business Mailing Address
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Address Line | 11316 W WADSWORTH RD STE 101
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City | BEACH PARK
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State | IL
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Zip | 60099-3367
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Country | US
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Telephone | 847-872-5530
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Fax | 847-872-1683
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Authorized Official
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Title or Position | PRESIDENT
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Name | TAYSEER AHMED IBRAHIM
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Credential | DDS
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Telephone | 847-872-5530
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 19-025457
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License Number State | IL
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