Provider Demographics
NPI:1629699715
Name:YOUSEF, JARDIN (DMD)
Entity Type:Individual
Prefix:DR
First Name:JARDIN
Middle Name:
Last Name:YOUSEF
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 1:1712 N LARCH DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-1647
Mailing Address - Country:US
Mailing Address - Phone:224-433-4733
Mailing Address - Fax:
Practice Address - Street 1:1S660 MIDWEST RD STE 205
Practice Address - Street 2:
Practice Address - City:OAKBROOK TERRACE
Practice Address - State:IL
Practice Address - Zip Code:60181-4738
Practice Address - Country:US
Practice Address - Phone:630-473-4550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-30
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019033881122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist