Provider Demographics
NPI:1962494633
Name:AHMED, NASIR J (DDS)
Entity Type:Individual
Prefix:
First Name:NASIR
Middle Name:J
Last Name:AHMED
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 1:1750 N RANDALL RD
Mailing Address - Street 2:SUITE # 270
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-7900
Mailing Address - Country:US
Mailing Address - Phone:847-888-0011
Mailing Address - Fax:847-888-0022
Practice Address - Street 1:1750 N RANDALL RD
Practice Address - Street 2:SUITE # 270
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-7900
Practice Address - Country:US
Practice Address - Phone:847-888-0011
Practice Address - Fax:847-888-0022
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-18
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0221321223G0001X
CADDS1035421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice