Provider Demographics
NPI:1083224257
Name:JAMALEDDIN, MOHAMMAD WASEEM HUSSEIN (DDS, MS)
Entity Type:Individual
Prefix:
First Name:MOHAMMAD WASEEM
Middle Name:HUSSEIN
Last Name:JAMALEDDIN
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1133 SOUTH BLVD APT 612
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-3279
Mailing Address - Country:US
Mailing Address - Phone:716-382-8700
Mailing Address - Fax:
Practice Address - Street 1:2300 W ARMITAGE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-4434
Practice Address - Country:US
Practice Address - Phone:773-697-4535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-03
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0328351223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty