MEDICARE: TAYSEER A IBRAHIM DDS PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	19-025457	IL

General Provider Information

NPI Number	:	1043209257
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TAYSEER A IBRAHIM DDS PC

Provider Business Mailing Address
First Line	:	11316 W WADSWORTH RD STE 101
Second Line	:
City	:	BEACH PARK
State	:	IL
Zip	:	60099-3367
Country	:	US
Telephone Number	:	847-872-5530
Fax Number	:	847-872-1683

Provider Business Practice Location Address
First Line	:	11316 W WADSWORTH RD STE 101
Second Line	:
City	:	BEACH PARK
State	:	IL
Zip	:	60099-3367
Country	:	US
Telephone Number	:	847-872-5530
Fax Number	:	847-872-1683

Authorized Official
Title or Position	:	PRESIDENT
Name	:	TAYSEER AHMED IBRAHIM
Credential	:	DDS
Telephone Number	:	847-872-5530

Provider Enumeration Date	:	10/19/2005
Last Update Date	:	09/02/2025

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