NPIMap

Organization Active NPI

Tayseer a Ibrahim DDS PC

Doing business as Wadsworth Dental

  • Dentist
  • Beach Park, IL
National Provider Identifier
1235356635
Registry record updated Jan 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
01925457 Issued in IL
Legal business name
TAYSEER A IBRAHIM DDS PC
Doing business as
Wadsworth Dental
Practice address
11316 W Wadsworth Rd
Beach Park, IL 60099-3367
Phone
(847) 872-5530
Fax
(847) 872-1683
NPI assigned
Apr 19, 2007
Last updated
Jan 22, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 22, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Tayseer Ahmed Ibrahim, DDSNPI 1336163484
Title
President
Phone
(847) 872-5530

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 01925457 IL Primary

Addresses

Primary practice location

11316 W Wadsworth Rd
Beach Park, IL 60099-3367

Mailing address

11316 W Wadsworth Rd
Beach Park, IL 60099-3367
Phone (847) 872-5530

Other names 1

  • WADSWORTH DENTAL Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Grand Yeoman Park Dental Care2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1611273600000",
    "number": "1235356635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11316 W WADSWORTH RD",
            "city": "BEACH PARK",
            "state": "IL",
            "postal_code": "600993367",
            "telephone_number": "847-872-5530",
            "fax_number": "847-872-1683"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11316 W WADSWORTH RD",
            "city": "BEACH PARK",
            "state": "IL",
            "postal_code": "600993367",
            "telephone_number": "847-872-5530",
            "fax_number": "847-872-1683"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TAYSEER A IBRAHIM DDS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-19",
        "last_updated": "2021-01-22",
        "certification_date": "2021-01-22",
        "status": "A",
        "authorized_official_last_name": "IBRAHIM",
        "authorized_official_first_name": "TAYSEER",
        "authorized_official_middle_name": "AHMED",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "847-872-5530",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "01925457",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WADSWORTH DENTAL",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "WADSWORTH DENTAL",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Beach Park, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.