Provider Demographics
NPI:1598495921
Name:HUSSAIN, SYED NADIR (DMD)
Entity Type:Individual
Prefix:
First Name:SYED
Middle Name:NADIR
Last Name:HUSSAIN
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 1:290 N RANDALL RD STE A
Mailing Address - Street 2:
Mailing Address - City:LAKE IN THE HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60156-5902
Mailing Address - Country:US
Mailing Address - Phone:224-678-9494
Mailing Address - Fax:
Practice Address - Street 1:290 N RANDALL RD STE A
Practice Address - Street 2:
Practice Address - City:LAKE IN THE HILLS
Practice Address - State:IL
Practice Address - Zip Code:60156-5902
Practice Address - Country:US
Practice Address - Phone:224-678-9494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-17
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019033701122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist