Provider Demographics
NPI:1639956758
Name:SAYED SULIMAN ATASSI, YAHYA (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:YAHYA
Middle Name:
Last Name:SAYED SULIMAN ATASSI
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1204 HAWTHORN CT
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62629-2075
Mailing Address - Country:US
Mailing Address - Phone:386-848-5740
Mailing Address - Fax:
Practice Address - Street 1:241 W WEAVER RD STE 220
Practice Address - Street 2:
Practice Address - City:FORSYTH
Practice Address - State:IL
Practice Address - Zip Code:62535-9769
Practice Address - Country:US
Practice Address - Phone:217-876-0547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-12
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.034585122300000X
IL021.0032901223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No122300000XDental ProvidersDentist