Provider Demographics
NPI:1356009542
Name:AHMED, MAHENOOR (DDS)
Entity Type:Individual
Prefix:DR
First Name:MAHENOOR
Middle Name:
Last Name:AHMED
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:903 S ASHLAND AVE APT 102
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-4094
Mailing Address - Country:US
Mailing Address - Phone:443-805-7595
Mailing Address - Fax:
Practice Address - Street 1:1044 N MOZART ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-2789
Practice Address - Country:US
Practice Address - Phone:773-772-9200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-04
Last Update Date:2021-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.033421122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty