Provider Demographics
NPI:1245429133
Name:ELSEWEIFI, YASSER AHMED (DDS)
Entity Type:Individual
Prefix:DR
First Name:YASSER
Middle Name:AHMED
Last Name:ELSEWEIFI
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 1:2002 N DAMEN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-4527
Mailing Address - Country:US
Mailing Address - Phone:773-276-2757
Mailing Address - Fax:773-276-2758
Practice Address - Street 1:2002 N DAMEN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-4527
Practice Address - Country:US
Practice Address - Phone:773-276-2757
Practice Address - Fax:773-276-2758
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-17
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019023492122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist