Provider Demographics
NPI:1750015210
Name:FAROOQ, ASAD (DMD)
Entity type:Individual
Prefix:
First Name:ASAD
Middle Name:
Last Name:FAROOQ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6300 KINGERY HWY STE 216
Mailing Address - Street 2:
Mailing Address - City:WILLOWBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60527-2254
Mailing Address - Country:US
Mailing Address - Phone:630-323-5333
Mailing Address - Fax:
Practice Address - Street 1:6300 KINGERY HWY STE 216
Practice Address - Street 2:
Practice Address - City:WILLOWBROOK
Practice Address - State:IL
Practice Address - Zip Code:60527-2254
Practice Address - Country:US
Practice Address - Phone:630-323-5333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-12
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019034637122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist