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General NPI Number Information
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NPI Number | 1083224257
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Entity Type | Individual
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Provider Name | MOHAMMAD WASEEM HUSSEIN JAMALEDDIN DDS, MS
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Gender | Male
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Dates
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Enumeration Date | 08/03/2020
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Last Update Date | 08/13/2020
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Provider Practice Location Address
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Address Line | 2300 W ARMITAGE AVE
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City | CHICAGO
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State | IL
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Zip | 60647-4434
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Country | US
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Telephone | 773-697-4535
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Fax |
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Provider Business Mailing Address
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Address Line | 1133 SOUTH BLVD APT 612
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City | OAK PARK
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State | IL
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Zip | 60302-3279
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Country | US
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Telephone | 716-382-8700
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Fax |
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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 | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 019.032835
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License Number State | IL
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