=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659282903
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MRA DENTAL SOLUTIONS P.L.L.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/15/2026
-----------------------------------------------------
Last Update Date | 09/15/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 690 N STATE ROUTE 31 STE G
-----------------------------------------------------
City | CRYSTAL LAKE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60012-3707
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-477-2177
-----------------------------------------------------
Fax | 815-477-8671
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 690 N STATE ROUTE 31 STE G
-----------------------------------------------------
City | CRYSTAL LAKE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60012-3707
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-477-2177
-----------------------------------------------------
Fax | 815-477-8671
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER, DENTIST
-----------------------------------------------------
Name | DR. MOHAMMAD R AHMAD
-----------------------------------------------------
Credential | D.M.D.
-----------------------------------------------------
Telephone | 708-590-9424
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------