Provider Demographics
NPI:1669643342
Name:KHALIL TAKLA DDS & ASSOCIATES PC
Entity Type:Organization
Organization Name:KHALIL TAKLA DDS & ASSOCIATES PC
Other - Org Name:ORLAND DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KHALIL
Authorized Official - Middle Name:
Authorized Official - Last Name:TAKLA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:708-364-8900
Mailing Address - Street 1:14360 S LA GRANGE RD
Mailing Address - Street 2:UNIT C
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-2063
Mailing Address - Country:US
Mailing Address - Phone:708-364-8900
Mailing Address - Fax:708-364-9875
Practice Address - Street 1:14360 S LA GRANGE RD
Practice Address - Street 2:UNIT C
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-2063
Practice Address - Country:US
Practice Address - Phone:708-364-8900
Practice Address - Fax:708-364-9875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-20
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190251351223G0001X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL332BC3200XOther332BC3200X