Provider Demographics
NPI:1972865491
Name:AHMAD, YOUSAF HASAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:YOUSAF
Middle Name:HASAN
Last Name:AHMAD
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 1:2415 BOWES RD STE 110
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-5535
Mailing Address - Country:US
Mailing Address - Phone:847-386-4300
Mailing Address - Fax:847-686-3622
Practice Address - Street 1:2415 BOWES RD STE 110
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-5535
Practice Address - Country:US
Practice Address - Phone:847-386-4300
Practice Address - Fax:847-686-3622
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-11
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20120178711223G0001X
IL0190301021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice