Provider Demographics
NPI:1831342377
Name:HUSSAIN, RAZA ALI (DMD)
Entity type:Individual
Prefix:DR
First Name:RAZA
Middle Name:ALI
Last Name:HUSSAIN
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 1:1025 W MONROE ST UNIT 3W
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-2745
Mailing Address - Country:US
Mailing Address - Phone:312-493-4265
Mailing Address - Fax:
Practice Address - Street 1:1025 W MONROE ST UNIT 3W
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-2745
Practice Address - Country:US
Practice Address - Phone:312-493-4265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0268591223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery