Provider Demographics
NPI:1730898933
Name:ORAL & MAXILLOFACIAL
Entity type:Organization
Organization Name:ORAL & MAXILLOFACIAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMED
Authorized Official - Middle Name:
Authorized Official - Last Name:QAISI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MD, FACS
Authorized Official - Phone:773-296-7645
Mailing Address - Street 1:25 E WASHINGTON ST STE 825
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-1722
Mailing Address - Country:US
Mailing Address - Phone:773-296-7645
Mailing Address - Fax:773-295-1023
Practice Address - Street 1:25 E WASHINGTON ST STE 825
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-1722
Practice Address - Country:US
Practice Address - Phone:773-296-7645
Practice Address - Fax:773-295-1023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-16
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Multi-Specialty