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General NPI Number Information
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NPI Number | 1881797579
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Entity Type | Organization
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Legal Business Name | DOKHANCHI DENTAL SERVICES, DDS, PC
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Dates
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Enumeration Date | 09/07/2006
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Last Update Date | 01/05/2019
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Provider Practice Location Address
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Address Line | 2424 W INDIAN TRL STE E
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City | AURORA
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State | IL
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Zip | 60506
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Country | US
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Telephone | 630-896-1086
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Fax |
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Provider Business Mailing Address
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Address Line | 2424 W INDIAN TRL STE E
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City | AURORA
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State | IL
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Zip | 60506-1588
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Country | US
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Telephone | 630-896-1086
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BABAK DOKHANCHI
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Credential | DDS
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Telephone | 630-896-1086
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019-023025
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License Number State | IL
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