Provider Demographics
NPI:1417547829
Name:NAWAZ, SYED
Entity Type:Individual
Prefix:
First Name:SYED
Middle Name:
Last Name:NAWAZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:917 PRAIRIE RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-7183
Mailing Address - Country:US
Mailing Address - Phone:630-321-9490
Mailing Address - Fax:
Practice Address - Street 1:917 PRAIRIE RIDGE CT
Practice Address - Street 2:
Practice Address - City:BURR RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60527-7183
Practice Address - Country:US
Practice Address - Phone:630-321-9490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-20
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0324911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice