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General NPI Number Information
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NPI Number | 1457499899
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Entity Type | Individual
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Provider Name | MOHAMED FAYAD D.D.S.,M.S.
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Gender | Male
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Dates
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Enumeration Date | 02/01/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 55 E WASHINGTON ST SUITE #1230
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City | CHICAGO
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State | IL
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Zip | 60602-2103
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Country | US
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Telephone | 312-236-9581
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Fax | 312-236-9593
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Provider Business Mailing Address
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Address Line | 2729A N GREENVIEW AVE
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City | CHICAGO
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State | IL
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Zip | 60614-1117
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Country | US
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Telephone | 312-236-9581
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Fax | 312-236-9593
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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 | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 19-025014
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License Number State | IL
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