Provider Demographics
NPI:1346548971
Name:AHASIC, GARY L (DMD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:L
Last Name:AHASIC
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 1:541 SULLIVAN RD
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-1406
Mailing Address - Country:US
Mailing Address - Phone:630-897-1156
Mailing Address - Fax:
Practice Address - Street 1:541 SULLIVAN RD
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-1406
Practice Address - Country:US
Practice Address - Phone:630-897-1156
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-07
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019015986122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist