Provider Demographics
NPI:1326762592
Name:MISBAHUDDIN, SYED MUHAMMAD (DDS)
Entity Type:Individual
Prefix:
First Name:SYED
Middle Name:MUHAMMAD
Last Name:MISBAHUDDIN
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 1:103 HEMSTEAD ST
Mailing Address - Street 2:
Mailing Address - City:LAKE BLUFF
Mailing Address - State:IL
Mailing Address - Zip Code:60044-1156
Mailing Address - Country:US
Mailing Address - Phone:612-516-2808
Mailing Address - Fax:
Practice Address - Street 1:2415 BOWES RD STE 110
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-5530
Practice Address - Country:US
Practice Address - Phone:847-386-4300
Practice Address - Fax:847-686-3622
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-30
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.033957122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist