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NPI Code Detail

MEDICARE: ABDUL ALEEM FAIYAZ DAVE D.D.S.

MEDICARE: ABDUL ALEEM FAIYAZ DAVE D.D.S.
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
11223G0001XGeneral Practice Dentistry019029450IL

General Provider Information

NPI Number : 1093075590
Entity Type Code : Individual
Provider Name (Legal Business Name) : ABDUL ALEEM FAIYAZ DAVE D.D.S.
Provider Business Mailing Address
First Line : 15 W FULLERTON AVE
Second Line :
City : GLENDALE HTS
State : IL
Zip : 60139-2648
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 21188 S LAGRANGE RD
Second Line :
City : FRANKFORT
State : IL
Zip : 60423-2010
Country : US
Telephone Number : 815-464-0412
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/18/2012
Last Update Date : 02/11/2015

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