Provider Demographics
NPI:1003540402
Name:AHMAD, CHRISTIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHRISTIN
Middle Name:
Last Name:AHMAD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7014 N KILBOURN AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60712-2217
Mailing Address - Country:US
Mailing Address - Phone:773-983-8810
Mailing Address - Fax:
Practice Address - Street 1:5206 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-2406
Practice Address - Country:US
Practice Address - Phone:773-561-5106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-12
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3190231821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice