Provider Demographics
NPI:1861015869
Name:HUSSAIN, SHAHVAR AZAL (DMD)
Entity Type:Individual
Prefix:
First Name:SHAHVAR
Middle Name:AZAL
Last Name:HUSSAIN
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 1:7455 KENNETH AVE
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-3817
Mailing Address - Country:US
Mailing Address - Phone:312-607-8382
Mailing Address - Fax:
Practice Address - Street 1:920 N ELMHURST RD
Practice Address - Street 2:
Practice Address - City:MT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-1126
Practice Address - Country:US
Practice Address - Phone:312-607-8382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-26
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0325581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice