MEDICARE: NOOR OBAISI, 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	122300000X	Dentist	019028304	IL

General Provider Information

NPI Number	:	1336580679
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOOR OBAISI, DDS, PC

Provider Business Mailing Address
First Line	:	3334 W PETERSON AVE
Second Line	:	LOWER LEVEL
City	:	CHICAGO
State	:	IL
Zip	:	60659-3505
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3334 W PETERSON AVE
Second Line	:	LOWER LEVEL
City	:	CHICAGO
State	:	IL
Zip	:	60659-3505
Country	:	US
Telephone Number	:	773-588-9200
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. NOOR OBAISI
Credential	:	DDS, MS
Telephone Number	:	217-314-0033

Provider Enumeration Date	:	07/15/2013
Last Update Date	:	07/15/2013

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