Individual
DR. AZZA AHMED
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BDS, MSC, PHD
Contact information
Practice address
801 S PAULINA ST, CHICAGO, IL 60612-7210
(312) 996-8640
Mailing address
801 S PAULINA ST # 269G, CHICAGO, IL 60612-7210
(317) 440-4959
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
019036485
IL
1223P0221X
Pediatric Dentistry
0
MA
1223P0221X
Pediatric Dentistry
Primary
021.003488
IL
1223P0221X
Pediatric Dentistry
Primary
136.000268
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0
—
MA
Enumeration date
02/25/2020
Last updated
03/09/2026
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