MEDICARE: IGOR N TIKHONOV DDS, MD

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	32448	TX

General Provider Information

NPI Number	:	1457618498
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IGOR N TIKHONOV DDS, MD

Provider Business Mailing Address
First Line	:	600 S DENTON TAP RD STE 300
Second Line	:
City	:	COPPELL
State	:	TX
Zip	:	75019-4533
Country	:	US
Telephone Number	:	206-719-8396
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 S DENTON TAP RD STE 300
Second Line	:
City	:	COPPELL
State	:	TX
Zip	:	75019-4533
Country	:	US
Telephone Number	:	206-719-8396
Fax Number	:	972-744-3305

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/16/2012
Last Update Date	:	04/03/2026

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