Provider Demographics
NPI:1538519368
Name:NOWEDER, AHMAD (DMD)
Entity Type:Individual
Prefix:
First Name:AHMAD
Middle Name:
Last Name:NOWEDER
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 1:10 W PHILLIP RD STE 105
Mailing Address - Street 2:
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-1730
Mailing Address - Country:US
Mailing Address - Phone:847-680-7171
Mailing Address - Fax:
Practice Address - Street 1:10 W PHILLIP RD STE 105
Practice Address - Street 2:
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-1730
Practice Address - Country:US
Practice Address - Phone:847-680-7171
Practice Address - Fax:224-788-8667
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-13
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190309751223G0001X
WI1001335-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist