Provider Demographics
NPI:1942561436
Name:HAFEEZ, TARIQ (DDS)
Entity Type:Individual
Prefix:DR
First Name:TARIQ
Middle Name:
Last Name:HAFEEZ
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 1:7923 LINCOLN AVE # 100
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-3681
Mailing Address - Country:US
Mailing Address - Phone:847-881-6636
Mailing Address - Fax:
Practice Address - Street 1:7923 LINCOLN AVE # 100
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-3681
Practice Address - Country:US
Practice Address - Phone:847-881-6636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-31
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010206651223G0001X
IL019.0293611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice