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General NPI Number Information
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NPI Number | 1689304602
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Entity Type | Individual
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Provider Name | DR. AMEENUDDIN SYED AHMED
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Gender | Male
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Dates
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Enumeration Date | 06/13/2022
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Last Update Date | 05/16/2023
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Provider Practice Location Address
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Address Line | 142 S GARY AVE STE 102
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City | BLOOMINGDALE
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State | IL
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Zip | 60108-2226
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Country | US
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Telephone | 630-283-0652
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Fax |
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Provider Business Mailing Address
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Address Line | 142 S GARY AVE STE 102
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City | BLOOMINGDALE
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State | IL
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Zip | 60108-2226
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Country | US
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Telephone |
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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 | DE61427701
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019.033605
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License Number State | IL
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