Provider Demographics
NPI:1700400074
Name:NAJJAR, ISMAEIL (DMD)
Entity Type:Individual
Prefix:
First Name:ISMAEIL
Middle Name:
Last Name:NAJJAR
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 1:903 S ASHLAND AVE APT 315
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-4096
Mailing Address - Country:US
Mailing Address - Phone:470-809-5335
Mailing Address - Fax:
Practice Address - Street 1:5917 S PULASKI RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60629-4515
Practice Address - Country:US
Practice Address - Phone:773-735-8353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-02
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019032667122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist