Provider Demographics
NPI:1225722895
Name:AYESHA, UNKNOWN (DDS)
Entity Type:Individual
Prefix:
First Name:UNKNOWN
Middle Name:
Last Name:AYESHA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:AYESHA
Other - Middle Name:
Other - Last Name:BAIG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:11214 N OAKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-1046
Mailing Address - Country:US
Mailing Address - Phone:309-360-1790
Mailing Address - Fax:
Practice Address - Street 1:368 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:EAST PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61611-2036
Practice Address - Country:US
Practice Address - Phone:309-694-4444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0342911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice