Provider Demographics
NPI:1275218000
Name:KAMAL, MIR AHMED (DMD)
Entity Type:Individual
Prefix:DR
First Name:MIR
Middle Name:AHMED
Last Name:KAMAL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 CLARISSA LN
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60502-7414
Mailing Address - Country:US
Mailing Address - Phone:331-431-1573
Mailing Address - Fax:
Practice Address - Street 1:110 N LARKIN AVE
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-6603
Practice Address - Country:US
Practice Address - Phone:815-310-3220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019034279122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist