Provider Demographics
NPI:1457618498
Name:TIKHONOV, IGOR N (DDS, MD)
Entity type:Individual
Prefix:
First Name:IGOR
Middle Name:N
Last Name:TIKHONOV
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 S DENTON TAP RD STE 300
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-4533
Mailing Address - Country:US
Mailing Address - Phone:206-719-8396
Mailing Address - Fax:
Practice Address - Street 1:600 S DENTON TAP RD STE 300
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-4533
Practice Address - Country:US
Practice Address - Phone:206-719-8396
Practice Address - Fax:972-744-3305
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-16
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX324481223S0112X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery