Provider Demographics
NPI:1326368028
Name:EJAZ TAHIR, DDS, MS, LTD
Entity Type:Organization
Organization Name:EJAZ TAHIR, DDS, MS, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EJAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:TAHIR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:708-636-9000
Mailing Address - Street 1:9501 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-3784
Mailing Address - Country:US
Mailing Address - Phone:708-636-9000
Mailing Address - Fax:708-636-9002
Practice Address - Street 1:9501 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-3784
Practice Address - Country:US
Practice Address - Phone:708-636-9000
Practice Address - Fax:708-636-9002
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EJAZ TAHIR, DDS, MS, LTD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-06-03
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190229901223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty