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Individual

DR. MOHAMMAD REZA EKHTERA

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DDS

Contact information

Practice address
3190 N. ELSTON AVE, CHICAGO, IL 60618-7129
(773) 564-9916
(872) 203-9984
Mailing address
3190 N. ELSTON AVE, CHICAGO, IL 60618-7129
(773) 564-9916
(872) 203-9984

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
019025849
IL
1223G0001X
General Practice Dentistry
Primary
019025849
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1005436
IL
Enumeration date
11/07/2005
Last updated
10/20/2025
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