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General NPI Number Information
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NPI Number | 1912236878
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Entity Type | Organization
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Legal Business Name | EJAZ TAHIR, DDS, MS, LTD
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Dates
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Enumeration Date | 12/23/2009
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Last Update Date | 12/23/2009
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Provider Practice Location Address
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Address Line | 2140 WESLEY AVE
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City | BERWYN
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State | IL
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Zip | 60402-1858
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Country | US
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Telephone | 708-484-8686
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Fax | 708-484-8687
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Provider Business Mailing Address
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Address Line | 2140 WESLEY AVE
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City | BERWYN
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State | IL
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Zip | 60402-1858
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Country | US
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Telephone | 708-484-8686
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Fax | 708-484-8687
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Authorized Official
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Title or Position | ORTHODONTIST
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Name | DR. EJAZ TAHIR
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Credential | D.D.S.
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Telephone | 708-484-8686
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 019022990
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License Number State | IL
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