MEDICARE: OMID KHAKSARFARD

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	1223G0001X	General Practice Dentistry	6001855	WI

General Provider Information

NPI Number	:	1780403477
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OMID KHAKSARFARD

Provider Business Mailing Address
First Line	:	233 LAKE AVE APT 228
Second Line	:
City	:	RACINE
State	:	WI
Zip	:	53403-1045
Country	:	US
Telephone Number	:	571-430-0432
Fax Number	:

Provider Business Practice Location Address
First Line	:	6035 DURAND AVE
Second Line	:
City	:	MT PLEASANT
State	:	WI
Zip	:	53406-5049
Country	:	US
Telephone Number	:	262-270-6933
Fax Number	:

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

Provider Enumeration Date	:	10/09/2024
Last Update Date	:	10/05/2025

Similar Medicare Providers

1093201964 — BRYSON SPEECH-LANGUAGE SERVICES
Practice Location Address:

15 W 6TH AVE STE 4H-2
HELENA, MT
59601-5049

Practice Phone: 406-579-3849
Practice Fax: 406-204-0205

1831955475 — OXFORD DENTAL LLC
Practice Location Address:

6035 DURAND AVE
MOUNT PLEASANT, WI
53406-5049

Practice Phone: 720-210-3078
Practice Fax:

1609627280 — SARA DARVISHIABYANEH
Practice Location Address:

6035 DURAND AVE
MOUNT PLEASANT, WI
53406-5049

Practice Phone: 262-270-6933
Practice Fax:

1568654333 — WISCONSIN VISION, LLC
Practice Location Address:

6035 DURAND AVE
RACINE, WI
53406-5049

Practice Phone: 262-554-8600
Practice Fax:

1285282558 — TESSA SINGLETON
Practice Location Address:

1410 W STATE RD
PLEASANT GROVE, UT
84062-5049

Practice Phone: 385-236-1974
Practice Fax:

1891557286 — CEDAR MOUNTAIN THERAPY & CONSULTATION
Practice Location Address:

1410 W STATE RD
PLEASANT GROVE, UT
84062-5049

Practice Phone: 385-236-1974
Practice Fax:

Directions to “ OMID KHAKSARFARD ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.