Rizwan Bader
Individual provider Active NPI Dentist · Addison, IL
NPI 1124756408 · NPPES record last updated Jun 20, 2024
Key facts
- NPI
- 1124756408
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 019.033920 (IL)
- Practice address
- 516 W Lake St
Addison, IL 60101-2307 - Phone
- (630) 576-0586
- NPI assigned
- Aug 12, 2022
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019.033920 | IL | MD | Dentist |
| 6001045 | WI | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dental Associates LTD of Wisconsin | Past |
Accepting new patients | |
| United Dental Anesthesia Partners | Past |
Accepting new patients | |
| True Dental Medpoint, LLC | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 6001045 | WI | |
| Dentist | 122300000X | 019.033920 | IL | Yes |
Addresses
Primary practice location
516 W Lake St
Addison, IL 60101-2307
Mailing address
516 W Lake St
Addison, IL 60101-2307
Phone (630) 279-3333
Other providers in Addison, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 20, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.