Provider Demographics
NPI:1780059063
Name:YOUSAF AHMAD DDS LLC
Entity type:Organization
Organization Name:YOUSAF AHMAD DDS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YOUSAF
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMAD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-386-4300
Mailing Address - Street 1:2415 BOWES RD
Mailing Address - Street 2:SUITE #110
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-5535
Mailing Address - Country:US
Mailing Address - Phone:847-386-4300
Mailing Address - Fax:
Practice Address - Street 1:2415 BOWES RD
Practice Address - Street 2:SUITE #110
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-5535
Practice Address - Country:US
Practice Address - Phone:847-386-4300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-11
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190301021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty