Asim Mohammad Ansari, D.D.S.
Individual provider Active NPI Dentist · Glen Ellyn, IL
NPI 1881904670 · NPPES record last updated Dec 10, 2015
Key facts
- NPI
- 1881904670
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 019028486 (IL)
- Practice address
- 2S733 Crimson King LN
Glen Ellyn, IL 60137-7229 - Phone
- (630) 254-9114
- NPI assigned
- Oct 14, 2010
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150611001370 | IL | Order and Referring Only - Dentist |
4789905019 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019028486 | IL | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Salud Family Dental | Dentist | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 019028486 | IL | Yes |
Addresses
Primary practice location
2S733 Crimson King LN
Glen Ellyn, IL 60137-7229
Mailing address
1037 E Woodfield Rd
Schaumburg, IL 60173-4706
Phone (847) 466-7392
Other providers in Glen Ellyn, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 10, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.