Provider Demographics
NPI:1548559024
Name:TOOTH FIXER DENTAL, PC
Entity Type:Organization
Organization Name:TOOTH FIXER DENTAL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KHAJA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHSINUDDIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-585-5600
Mailing Address - Street 1:2460 S EOLA RD
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60503-6494
Mailing Address - Country:US
Mailing Address - Phone:630-585-5600
Mailing Address - Fax:630-585-5656
Practice Address - Street 1:2460 S EOLA RD
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60503-6494
Practice Address - Country:US
Practice Address - Phone:630-585-5600
Practice Address - Fax:630-585-5656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-05
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190252081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty