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General NPI Number Information
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NPI Number | 1043412620
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Entity Type | Individual
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Provider Name | MOHAMMED ADIL ASIM DDS
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Gender | Male
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Dates
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Enumeration Date | 06/05/2007
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Last Update Date | 06/16/2016
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Provider Practice Location Address
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Address Line | 4434 W FULLERTON AVE
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City | CHICAGO
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State | IL
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Zip | 60639-1932
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Country | US
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Telephone | 773-486-6500
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Fax | 773-486-6556
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Provider Business Mailing Address
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Address Line | 75 W. NORTH AVE SUITE 400
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City | NORTHLAKE
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State | IL
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Zip | 60164
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Country | US
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Telephone | 708-562-5100
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Fax | 708-562-5112
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 019027367
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 019027367
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License Number State | IL
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