Provider Demographics
NPI:1689888315
Name:NAKFOOR, BRYAN PATRICK (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:PATRICK
Last Name:NAKFOOR
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 S DUNTON AVE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005
Mailing Address - Country:US
Mailing Address - Phone:847-392-0330
Mailing Address - Fax:847-394-2845
Practice Address - Street 1:102 S DUNTON AVE
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005
Practice Address - Country:US
Practice Address - Phone:847-392-0330
Practice Address - Fax:847-394-2845
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901019094122300000X, 1223G0001X
IL021.0022901223X0400X
IL019.027309122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice