Provider Demographics
NPI:1588009427
Name:KARIMI-ARDEKANI, KOUROSH (DDS)
Entity Type:Individual
Prefix:DR
First Name:KOUROSH
Middle Name:
Last Name:KARIMI-ARDEKANI
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 1:9236 MULLEN HILL RD
Mailing Address - Street 2:
Mailing Address - City:AVA
Mailing Address - State:NY
Mailing Address - Zip Code:13303-1928
Mailing Address - Country:US
Mailing Address - Phone:315-723-8856
Mailing Address - Fax:
Practice Address - Street 1:350 N. CLARK STREET, 6TH FLOOR
Practice Address - Street 2:DENTAL DREAMS LLC
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654
Practice Address - Country:US
Practice Address - Phone:312-274-4520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-06
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
DCDEN1001278122300000X
MD15515122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program