Provider Demographics
NPI:1801221510
Name:PARDESI, AYESHA HUSAIN (DMD)
Entity Type:Individual
Prefix:MRS
First Name:AYESHA
Middle Name:HUSAIN
Last Name:PARDESI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:AYESHA
Other - Middle Name:
Other - Last Name:HUSAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1508 COCALICO CT
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-2591
Mailing Address - Country:US
Mailing Address - Phone:949-233-3130
Mailing Address - Fax:
Practice Address - Street 1:4015 PLAINFIELD NAPERVILLE RD
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-4238
Practice Address - Country:US
Practice Address - Phone:630-326-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-12
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.031281122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1801221510Medicaid