Provider Demographics
NPI:1891448817
Name:HUSSAIN, RAZA (DDS)
Entity Type:Individual
Prefix:DR
First Name:RAZA
Middle Name:
Last Name:HUSSAIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1447 PRESIDENT ST
Mailing Address - Street 2:
Mailing Address - City:GLENDALE HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60139-3602
Mailing Address - Country:US
Mailing Address - Phone:630-648-9417
Mailing Address - Fax:
Practice Address - Street 1:10155 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:STURTEVANT
Practice Address - State:WI
Practice Address - Zip Code:53177-1645
Practice Address - Country:US
Practice Address - Phone:262-884-0111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-31
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI60011261223G0001X
IL019.0335001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice