MEDICARE: DR. HAYDER F. BAHRANI D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	5679-015	WI
2	122300000X	Dentist		IL

General Provider Information

NPI Number	:	1740380591
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HAYDER F. BAHRANI D.D.S.

Provider Business Mailing Address
First Line	:	1423 N PINEHURST DR
Second Line	:
City	:	VERNON HILLS
State	:	IL
Zip	:	60061-1230
Country	:	US
Telephone Number	:	847-984-2527
Fax Number	:

Provider Business Practice Location Address
First Line	:	1423 N PINEHURST DR
Second Line	:
City	:	VERNON HILLS
State	:	IL
Zip	:	60061-1230
Country	:	US
Telephone Number	:	847-984-2527
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	07/08/2007

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