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General NPI Number Information
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NPI Number | 1598163305
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Entity Type | Organization
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Legal Business Name | ELITE DENTISTRY PC
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Dates
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Enumeration Date | 12/10/2014
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Last Update Date | 12/10/2014
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Provider Practice Location Address
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Address Line | 24 DENNISON DR
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City | GLENDALE HEIGHTS
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State | IL
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Zip | 60139-1875
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Country | US
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Telephone | 630-201-1969
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Fax | 630-295-8408
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Provider Business Mailing Address
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Address Line | 24 DENNISON DR
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City | GLENDALE HEIGHTS
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State | IL
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Zip | 60139-1875
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Country | US
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Telephone | 630-201-1969
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Fax | 630-295-8408
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MOHAMED WAHEED
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Credential | D.D.S
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Telephone | 630-201-1969
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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 | 019028978
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License Number State | IL
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