Provider Demographics
NPI:1821652736
Name:ORAL AND MAXILLOFICIAL HEAD AND NECK ASSOCIATES LLC
Entity Type:Organization
Organization Name:ORAL AND MAXILLOFICIAL HEAD AND NECK ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMED
Authorized Official - Middle Name:
Authorized Official - Last Name:QAISI
Authorized Official - Suffix:
Authorized Official - Credentials:MD DMD
Authorized Official - Phone:318-547-2825
Mailing Address - Street 1:PO BOX 734471
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-4471
Mailing Address - Country:US
Mailing Address - Phone:847-676-0091
Mailing Address - Fax:847-676-2374
Practice Address - Street 1:811 WEST WELLINGTON AVENUE
Practice Address - Street 2:ATTENTION: MOHAMMED QAISI, MD., DMD.
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-5123
Practice Address - Country:US
Practice Address - Phone:847-676-0091
Practice Address - Fax:847-676-2374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-25
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty