Provider Demographics
NPI:1659144632
Name:ISMAIL, MOHAMMED SHAHER (DDS)
Entity type:Individual
Prefix:DR
First Name:MOHAMMED
Middle Name:SHAHER
Last Name:ISMAIL
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 1:50 YORKTOWN SHOPPING CTR UNIT 303
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-5630
Mailing Address - Country:US
Mailing Address - Phone:708-267-9299
Mailing Address - Fax:
Practice Address - Street 1:107 W LAKE ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-1027
Practice Address - Country:US
Practice Address - Phone:630-349-2030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-01
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019034652122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist