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General NPI Number Information
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NPI Number | 1275105165
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Entity Type | Organization
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Legal Business Name | NAPERVILLE DENTISTRY LLC
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Dates
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Enumeration Date | 07/12/2021
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Last Update Date | 07/12/2021
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Provider Practice Location Address
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Address Line | 1568 W OGDEN AVE STE 108
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City | NAPERVILLE
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State | IL
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Zip | 60540-4090
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Country | US
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Telephone | 630-247-7216
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Fax | 773-787-2400
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Provider Business Mailing Address
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Address Line | 3924 S ARCHER AVE UNIT D
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City | CHICAGO
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State | IL
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Zip | 60632-1116
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Country | US
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Telephone | 630-247-7216
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Fax | 773-787-2400
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | HAMZA MOHAMMED
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Credential |
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Telephone | 630-247-7216
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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