MEDICARE: MR. MOHAMMAD HOSSEIN RANJBARI 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	1223G0001X	General Practice Dentistry		IL

General Provider Information

NPI Number	:	1851500078
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MOHAMMAD HOSSEIN RANJBARI DDS

Provider Business Mailing Address
First Line	:	1718 S ASHLAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608-2015
Country	:	US
Telephone Number	:	312-421-9500
Fax Number	:	312-421-1321

Provider Business Practice Location Address
First Line	:	1718 S ASHLAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608-2015
Country	:	US
Telephone Number	:	312-421-9500
Fax Number	:	312-421-1321

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

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	07/08/2007

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