Provider Demographics
NPI:1649612839
Name:QURESHI, ISAAC A (DDS)
Entity type:Individual
Prefix:DR
First Name:ISAAC
Middle Name:A
Last Name:QURESHI
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 1:1400 W 47TH ST
Mailing Address - Street 2:UNIT 7
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-6141
Mailing Address - Country:US
Mailing Address - Phone:708-482-4420
Mailing Address - Fax:708-482-4421
Practice Address - Street 1:1400 W 47TH ST STE 7
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525-6148
Practice Address - Country:US
Practice Address - Phone:708-482-4420
Practice Address - Fax:708-482-4421
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-29
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-029531122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist