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General NPI Number Information
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NPI Number | 1568283257
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Entity Type | Individual
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Provider Name | SADAF ASHOURI DMD
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Gender | Female
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Dates
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Enumeration Date | 10/24/2024
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Last Update Date | 10/24/2024
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Provider Practice Location Address
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Address Line | 3834 N ASHLAND AVE
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City | CHICAGO
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State | IL
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Zip | 60613-2766
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Country | US
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Telephone | 773-404-8030
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Fax |
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Provider Business Mailing Address
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Address Line | 1201 W ADAMS ST APT 1003
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City | CHICAGO
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State | IL
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Zip | 60607-2952
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Country | US
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Telephone | 832-709-7099
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019035554
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License Number State | IL
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