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General NPI Number Information
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NPI Number | 1659144632
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Entity Type | Individual
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Provider Name | MOHAMMED SHAHER ISMAIL DDS
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Gender | Male
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Dates
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Enumeration Date | 11/01/2023
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Last Update Date | 11/17/2023
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Provider Practice Location Address
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Address Line | 107 W LAKE ST
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City | BLOOMINGDALE
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State | IL
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Zip | 60108-1027
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Country | US
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Telephone | 630-349-2030
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Fax |
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Provider Business Mailing Address
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Address Line | 50 YORKTOWN SHOPPING CTR UNIT 303
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City | LOMBARD
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State | IL
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Zip | 60148-5630
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Country | US
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Telephone | 708-267-9299
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 019034652
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License Number State | IL
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