Provider Demographics
NPI:1043412620
Name:ASIM, MOHAMMED ADIL (DDS)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMED
Middle Name:ADIL
Last Name:ASIM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:MOHAMMED
Other - Middle Name:ADIL
Other - Last Name:ASIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:75 W. NORTH AVE SUITE 400
Mailing Address - Street 2:
Mailing Address - City:NORTHLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60164
Mailing Address - Country:US
Mailing Address - Phone:708-562-5100
Mailing Address - Fax:708-562-5112
Practice Address - Street 1:4434 W FULLERTON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60639-1932
Practice Address - Country:US
Practice Address - Phone:773-486-6500
Practice Address - Fax:773-486-6556
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190273671223G0001X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics