Individual
DR. HIDAYATHULLA KHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
121 E ROOSEVELT RD, LOMBARD, IL 60148-4561
(224) 766-9876
Mailing address
4948 LOUISE ST APT 1W, SKOKIE, IL 60077-2937
(224) 766-9876
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019030623
IL
122300000X
Dentist
1001343-15
WI
Other
Enumeration date
07/20/2016
Last updated
07/20/2016
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