Healthcare Provider Details

I. General information

NPI: 1083398911
Provider Name (Legal Business Name): FAISAL KHAN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2023
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6160 S CASS AVE STE E
WESTMONT IL
60559-2685
US

IV. Provider business mailing address

2732 BRECKENRIDGE LN
NAPERVILLE IL
60565-5338
US

V. Phone/Fax

Practice location:
  • Phone: 630-812-7755
  • Fax:
Mailing address:
  • Phone: 630-667-5053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019.035408
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: