Provider Demographics
NPI:1235702309
Name:YOUSSEF, AHMED YEHIA SHAWKY AHMED (DDS)
Entity type:Individual
Prefix:
First Name:AHMED
Middle Name:YEHIA SHAWKY AHMED
Last Name:YOUSSEF
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 1:1220 HOBSON RD STE 228
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-8138
Mailing Address - Country:US
Mailing Address - Phone:651-675-6055
Mailing Address - Fax:
Practice Address - Street 1:1220 HOBSON RD STE 228
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-8138
Practice Address - Country:US
Practice Address - Phone:651-675-6055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-19
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0340481223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100215745Medicaid