Provider Demographics
NPI:1366695751
Name:ALBAZZAZ, MICHAEL BASHEER (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:BASHEER
Last Name:ALBAZZAZ
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 PEARSON STREET
Mailing Address - Street 2:UNIT 701
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-9218
Mailing Address - Country:US
Mailing Address - Phone:312-799-0423
Mailing Address - Fax:
Practice Address - Street 1:400 GOLF MILL CTR
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-1222
Practice Address - Country:US
Practice Address - Phone:847-296-6686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-29
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019026794122300000X
IL0210022871223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist