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General NPI Number Information
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NPI Number | 1255900437
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Entity Type | Individual
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Provider Name | MAHA KHADEN DMD
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Gender | Female
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Dates
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Enumeration Date | 06/22/2021
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Last Update Date | 06/22/2021
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Provider Practice Location Address
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Address Line | 9327 SKOKIE BLVD UNIT C
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City | SKOKIE
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State | IL
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Zip | 60077-1310
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Country | US
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Telephone | 847-227-8277
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Fax |
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Provider Business Mailing Address
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Address Line | 2400 ARCHBURY LN APT 1C
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City | PARK RIDGE
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State | IL
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Zip | 60068-3672
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Country | US
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Telephone | 847-877-0293
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019.033161
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019.033161
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License Number State | IL
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