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General NPI Number Information
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NPI Number | 1730898933
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Entity Type | Organization
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Legal Business Name | ORAL & MAXILLOFACIAL
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Dates
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Enumeration Date | 11/16/2022
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Last Update Date | 11/16/2022
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Provider Practice Location Address
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Address Line | 25 E WASHINGTON ST STE 825
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City | CHICAGO
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State | IL
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Zip | 60602-1722
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Country | US
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Telephone | 773-296-7645
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Fax | 773-295-1023
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Provider Business Mailing Address
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Address Line | 25 E WASHINGTON ST STE 825
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City | CHICAGO
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State | IL
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Zip | 60602-1722
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Country | US
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Telephone | 773-296-7645
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Fax | 773-295-1023
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Authorized Official
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Title or Position | OWNER
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Name | DR. MOHAMMED QAISI
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Credential | DMD, MD, FACS
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Telephone | 773-296-7645
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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