Healthcare Provider Details

I. General information

NPI: 1801068457
Provider Name (Legal Business Name): BRIGHT DENTAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2008
Last Update Date: 03/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

837 WESTMORE MEYERS RD SUITE B
LOMBARD IL
60148-3724
US

IV. Provider business mailing address

837 WESTMORE MEYERS RD SUITE B
LOMBARD IL
60148-3724
US

V. Phone/Fax

Practice location:
  • Phone: 630-620-4364
  • Fax: 630-620-1779
Mailing address:
  • Phone: 630-620-4364
  • Fax: 630-620-1779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. KHALIL TAKLA
Title or Position: OWNER
Credential: DDS
Phone: 630-620-4364