Provider Demographics
NPI:1093075590
Name:DAVE, ABDUL ALEEM FAIYAZ (DDS)
Entity Type:Individual
Prefix:
First Name:ABDUL ALEEM
Middle Name:FAIYAZ
Last Name:DAVE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 W FULLERTON AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE HTS
Mailing Address - State:IL
Mailing Address - Zip Code:60139-2648
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:21188 S LAGRANGE RD
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-2010
Practice Address - Country:US
Practice Address - Phone:815-464-0412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-18
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190294501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice