Provider Demographics
NPI:1295993764
Name:HARJINDER KHAIRA D.M.D. & ASSOCIATES PC
Entity type:Organization
Organization Name:HARJINDER KHAIRA D.M.D. & ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HARJINDER
Authorized Official - Middle Name:S
Authorized Official - Last Name:KHAIRA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:630-894-8008
Mailing Address - Street 1:490 W LAKE ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:ROSELLE
Mailing Address - State:IL
Mailing Address - Zip Code:60172-3583
Mailing Address - Country:US
Mailing Address - Phone:630-894-8008
Mailing Address - Fax:630-894-0908
Practice Address - Street 1:490 W LAKE ST
Practice Address - Street 2:SUITE 107
Practice Address - City:ROSELLE
Practice Address - State:IL
Practice Address - Zip Code:60172-3583
Practice Address - Country:US
Practice Address - Phone:630-894-8008
Practice Address - Fax:630-894-0908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-30
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190246921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty