Provider Demographics
NPI:1063105575
Name:BADER, MOHAMMAD (DMD)
Entity type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:
Last Name:BADER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:MOHAMMAD
Other - Middle Name:I
Other - Last Name:BADER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:333 E ONTARIO ST APT 4403
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-4895
Mailing Address - Country:US
Mailing Address - Phone:847-387-0377
Mailing Address - Fax:
Practice Address - Street 1:4849 W BELMONT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641-4330
Practice Address - Country:US
Practice Address - Phone:773-735-8353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-31
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190342781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice