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General NPI Number Information
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NPI Number | 1881904670
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Entity Type | Individual
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Provider Name | ASIM MOHAMMAD ANSARI D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 10/14/2010
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Last Update Date | 12/10/2015
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Provider Practice Location Address
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Address Line | 2S733 CRIMSON KING LN
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City | GLEN ELLYN
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State | IL
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Zip | 60137-7229
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Country | US
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Telephone | 630-254-9114
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Fax |
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Provider Business Mailing Address
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Address Line | 1037 E WOODFIELD RD
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City | SCHAUMBURG
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State | IL
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Zip | 60173-4706
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Country | US
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Telephone | 847-466-7392
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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 | 019028486
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License Number State | IL
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