Lyla H Azzam, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

019.033 Issued in IL

Practice address

1177 Bloomingdale Rd Ste B
Glendale Heights, IL 60139-3402

Phone

(630) 866-3000

NPI assigned

Mar 26, 2020

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Glendale Heights Dental P.C.

  dba Glendale Heights Family Dental

  • General Practice Dentistry
  • Glendale Heights, IL
  • NPI 1447644828

  Single Specialty

  NPD (past)

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

{
    "created_epoch": "1585180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673568000000",
    "number": "1255968368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1177 BLOOMINGDALE RD STE B",
            "city": "GLENDALE HEIGHTS",
            "state": "IL",
            "postal_code": "601393402",
            "telephone_number": "630-866-6000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1177 BLOOMINGDALE RD STE B",
            "city": "GLENDALE HEIGHTS",
            "state": "IL",
            "postal_code": "601393402",
            "telephone_number": "630-866-3000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "Zufall Health Center",
            "address_2": "18 West Blackwell Street",
            "address_purpose": "LOCATION",
            "city": "Dover",
            "state": "NJ",
            "postal_code": "07801",
            "country_code": "US",
            "telephone_number": "973-328-9100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "AZZAM",
        "first_name": "LYLA",
        "middle_name": "H",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-03-26",
        "last_updated": "2023-01-13",
        "certification_date": "2023-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NY",
            "license": "062029",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019.033",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dean A Aspito, D.D.S.
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• Alexis Ayala
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• Shafeeq H Bader, DDS
• Zishan Bader, D.D.S.
• Mohammed Abdul Basith, MD
• Lisa Nadine Beck, LCSW

• Dentist in Glendale Heights, IL
• Providers in Glendale Heights, IL by specialty
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2023; 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.