Healthcare Provider Details

I. General information

NPI: 1376474163
Provider Name (Legal Business Name): CHRISTINE NIKNAM LEILABADI DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6317 FAIRVIEW AVE STE 6
WESTMONT IL
60559-2804
US

IV. Provider business mailing address

801 JEFFERSON ST
HINSDALE IL
60521-3624
US

V. Phone/Fax

Practice location:
  • Phone: 630-496-7005
  • Fax:
Mailing address:
  • Phone: 206-303-7821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019.036980
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019.036980
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: