Individual
HUSAM HIWIADI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
3953 FOUNTAIN SQUARE PL, WAUKEGAN, IL 60085-6705
(817) 793-8559
Mailing address
450 WARRENVILLE RD APT 455, LISLE, IL 60532-1664
(817) 793-8559
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019.033617
IL
Other
Enumeration date
06/21/2022
Last updated
06/29/2022
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