Provider Demographics
NPI:1376192203
Name:AL-KURDI, SHAZAD S (DMD)
Entity Type:Individual
Prefix:DR
First Name:SHAZAD
Middle Name:S
Last Name:AL-KURDI
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 1:36W935 WILDMERE DR
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-4806
Mailing Address - Country:US
Mailing Address - Phone:773-551-9490
Mailing Address - Fax:
Practice Address - Street 1:9539A S CICERO AVE
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-3136
Practice Address - Country:US
Practice Address - Phone:773-551-9490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-04
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0321711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice