Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 19025042 | IL |
NPI | 1003948894 |
---|---|
Provider Name | Dr. Samar Islam |
First Address | Downers Grove, IL 60516 |
Second Address | Downers Grove, IL 60516 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2007 |
Last Update Date | 08/07/2007 |