Individual provider Active NPI

Ilyas M Ahmed, DDS

  • General Practice Dentistry
  • Northlake, IL
National Provider Identifier
1447363643
Registry record updated Sep 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
019026721 Issued in IL
Practice address
75 W North Ave
Northlake, IL 60164-2306
Phone
(708) 562-5100
Fax
(708) 562-5112
NPI assigned
Aug 15, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 019026721 IL Primary
Dentist 122300000X 019026721 IL

Addresses

Primary practice location

75 W North Ave
Northlake, IL 60164-2306

Mailing address

75 W North Ave Ste 400
Northlake, IL 60164-2314
Phone (708) 562-5100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160511002160 IL Order and Referring Only - DentistPractitioner - Dentist 4486943628

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
019026721ILMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Dental Starz, LLC Past Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1155600000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757894400000",
    "number": "1447363643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "75 W NORTH AVE STE 400",
            "city": "NORTHLAKE",
            "state": "IL",
            "postal_code": "601642314",
            "telephone_number": "708-562-5100",
            "fax_number": "708-562-5112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75 W NORTH AVE",
            "city": "NORTHLAKE",
            "state": "IL",
            "postal_code": "601642306",
            "telephone_number": "708-562-5100",
            "fax_number": "708-562-5112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AHMED",
        "first_name": "ILYAS",
        "middle_name": "M",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-15",
        "last_updated": "2025-09-15",
        "certification_date": "2025-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019026721",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019026721",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Northlake, IL

Sources for this page

Verify at the official NPI Registry.