=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679416275
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HAIDER W ALJEWARI DMD MS PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/10/2026
-----------------------------------------------------
Last Update Date | 04/10/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3002 CROSSING CT
-----------------------------------------------------
City | CHAMPAIGN
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61822-6135
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 217-398-4867
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2514 FIELDS SOUTH DR APT 206
-----------------------------------------------------
City | CHAMPAIGN
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61822-3724
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-414-5979
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EMPLOYEE
-----------------------------------------------------
Name | HAIDER ALJEWARI
-----------------------------------------------------
Credential | DMD, MS
-----------------------------------------------------
Telephone | 956-414-5979
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0300X
-----------------------------------------------------
Taxonomy Name | Periodontics
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------