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NPI Code Detail

MEDICARE: ALENA BUKHAR DMD

MEDICARE: ALENA BUKHAR DMD
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
1122300000XDentist019031343IL
21223X0400XOrthodontics and Dentofacial Orthopedics Dentistry021002878IL

General Provider Information

NPI Number : 1861905028
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALENA BUKHAR DMD
Provider Business Mailing Address
First Line : 1210 S INDIANA AVE APT 1016
Second Line :
City : CHICAGO
State : IL
Zip : 60605-2773
Country : US
Telephone Number : 347-394-8165
Fax Number :
Provider Business Practice Location Address
First Line : 3435 W IRVING PARK RD
Second Line :
City : CHICAGO
State : IL
Zip : 60618-3217
Country : US
Telephone Number : 773-588-8200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/09/2017
Last Update Date : 11/07/2019

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