Organization
ORAL & MAXILLOFACIAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MOHAMMED QAISI DMD, MD, FACS (OWNER)
(773) 296-7645
Entity
Organization
Contact information
Practice address
25 E WASHINGTON ST STE 825, CHICAGO, IL 60602-1722
(773) 296-7645
(773) 295-1023
Mailing address
25 E WASHINGTON ST STE 825, CHICAGO, IL 60602-1722
(773) 296-7645
(773) 295-1023
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
—
—
Other
Enumeration date
11/16/2022
Last updated
11/16/2022
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