MEDICARE: DR. MOHAMED S WAHEED DDS

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	019028978	IL

General Provider Information

NPI Number	:	1124389069
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MOHAMED S WAHEED DDS

Provider Business Mailing Address
First Line	:	24 DENNISON DR
Second Line	:
City	:	GLENDALE HEIGHTS
State	:	IL
Zip	:	60139-1875
Country	:	US
Telephone Number	:	163-020-1196
Fax Number	:

Provider Business Practice Location Address
First Line	:	24 DENNISON DR
Second Line	:
City	:	GLENDALE HEIGHTS
State	:	IL
Zip	:	60139-1875
Country	:	US
Telephone Number	:	163-020-1196
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2012
Last Update Date	:	06/07/2012

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