MEDICARE: ARDESHIR RAGHIAN DDS PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	019024426	IL

General Provider Information

NPI Number	:	1417354093
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARDESHIR RAGHIAN DDS PC

Provider Business Mailing Address
First Line	:	5841 W BELMONT AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60634-5201
Country	:	US
Telephone Number	:	773-622-3454
Fax Number	:	773-622-0990

Provider Business Practice Location Address
First Line	:	5841 W BELMONT AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60634-5201
Country	:	US
Telephone Number	:	773-622-3454
Fax Number	:	773-622-0990

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. ARDESHIR RAGHIAN
Credential	:	DDS
Telephone Number	:	773-622-3454

Provider Enumeration Date	:	11/26/2014
Last Update Date	:	04/07/2025

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