=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659798239
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ADNAN ISMAIL ALAMDI SR. DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/21/2014
-----------------------------------------------------
Last Update Date | 03/21/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2501 W PIERSON RD
-----------------------------------------------------
City | FLINT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48504-6802
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-522-3015
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 350 N CLARK ST 6TH FLOOR CHICAGO
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60654-4712
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-522-3015
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 2901021157
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------