Provider Demographics
NPI:1487211694
Name:HEGAZY, AHMED M (BDSDMD)
Entity Type:Individual
Prefix:DR
First Name:AHMED
Middle Name:M
Last Name:HEGAZY
Suffix:
Gender:M
Credentials:BDSDMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1629 S PRAIRIE AVE UNIT 902
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-5058
Mailing Address - Country:US
Mailing Address - Phone:646-270-0496
Mailing Address - Fax:
Practice Address - Street 1:7250 S CICERO AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60629-5849
Practice Address - Country:US
Practice Address - Phone:708-496-8896
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-22
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0321031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice