MEDICARE: FAISAL ALNAASAN 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	019.033993	IL

General Provider Information

NPI Number	:	1962119859
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FAISAL ALNAASAN DDS

Provider Business Mailing Address
First Line	:	1210 S INDIANA AVE APT 2009
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60605-2782
Country	:	US
Telephone Number	:	347-755-8607
Fax Number	:

Provider Business Practice Location Address
First Line	:	3425 S KING DR
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-4108
Country	:	US
Telephone Number	:	312-313-9777
Fax Number	:

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

Provider Enumeration Date	:	11/01/2022
Last Update Date	:	11/01/2022

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