MEDICARE: DR. TASHA DHIR DDS

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	019030953	IL

General Provider Information

NPI Number	:	1801343090
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TASHA DHIR DDS

Provider Business Mailing Address
First Line	:	11041 W 179TH ST
Second Line	:
City	:	ORLAND PARK
State	:	IL
Zip	:	60467-9452
Country	:	US
Telephone Number	:	708-478-5093
Fax Number	:	708-478-5096

Provider Business Practice Location Address
First Line	:	11041 W 179TH ST
Second Line	:
City	:	ORLAND PARK
State	:	IL
Zip	:	60467-9452
Country	:	US
Telephone Number	:	708-478-5093
Fax Number	:	708-478-5096

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

Provider Enumeration Date	:	09/06/2016
Last Update Date	:	09/06/2016

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