Healthcare Provider Details

I. General information

NPI: 1669643342
Provider Name (Legal Business Name): KHALIL TAKLA DDS & ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2008
Last Update Date: 10/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14360 S LA GRANGE RD UNIT C
ORLAND PARK IL
60462-2063
US

IV. Provider business mailing address

14360 S LA GRANGE RD UNIT C
ORLAND PARK IL
60462-2063
US

V. Phone/Fax

Practice location:
  • Phone: 708-364-8900
  • Fax: 708-364-9875
Mailing address:
  • Phone: 708-364-8900
  • Fax: 708-364-9875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019025135
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. KHALIL TAKLA
Title or Position: OWNER
Credential: DDS
Phone: 708-364-8900