Provider Demographics
NPI:1851500078
Name:RANJBARI, MOHAMMAD HOSSEIN (DDS)
Entity Type:Individual
Prefix:MR
First Name:MOHAMMAD
Middle Name:HOSSEIN
Last Name:RANJBARI
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 1:1718 S ASHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-2015
Mailing Address - Country:US
Mailing Address - Phone:312-421-9500
Mailing Address - Fax:312-421-1321
Practice Address - Street 1:1718 S ASHLAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-2015
Practice Address - Country:US
Practice Address - Phone:312-421-9500
Practice Address - Fax:312-421-1321
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice