Provider Demographics
NPI:1205030475
Name:TAGHIPOUR, ALI (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALI
Middle Name:
Last Name:TAGHIPOUR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:916 W BELMONT AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-4427
Mailing Address - Country:US
Mailing Address - Phone:773-840-8484
Mailing Address - Fax:872-829-3561
Practice Address - Street 1:916 W BELMONT AVE STE 201
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-4427
Practice Address - Country:US
Practice Address - Phone:773-840-8484
Practice Address - Fax:872-829-3561
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190273961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice