MEDICARE: UMAR PASHA 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	122300000X	Dentist	019033933	IL

General Provider Information

NPI Number	:	1538896667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	UMAR PASHA DDS

Provider Business Mailing Address
First Line	:	1074 MAPLE LN
Second Line	:
City	:	NEW HYDE PARK
State	:	NY
Zip	:	11040-2306
Country	:	US
Telephone Number	:	516-524-9361
Fax Number	:

Provider Business Practice Location Address
First Line	:	3540 N ASHLAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-1314
Country	:	US
Telephone Number	:	708-740-5972
Fax Number	:

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

Provider Enumeration Date	:	08/08/2022
Last Update Date	:	08/08/2022

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