Provider Demographics
NPI:1407206618
Name:ALKHANDAK, IMAN
Entity Type:Individual
Prefix:
First Name:IMAN
Middle Name:
Last Name:ALKHANDAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4028 W JERELIN DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132-8727
Mailing Address - Country:US
Mailing Address - Phone:414-581-8124
Mailing Address - Fax:
Practice Address - Street 1:4028 W JERELIN DR
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:WI
Practice Address - Zip Code:53132-8727
Practice Address - Country:US
Practice Address - Phone:414-581-8124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-18
Last Update Date:2016-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1001337-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist