Provider Demographics
NPI:1700447174
Name:CHEHEL AMIRAN, NADER
Entity type:Individual
Prefix:DR
First Name:NADER
Middle Name:
Last Name:CHEHEL AMIRAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 S WARREN AVE
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60074-6408
Mailing Address - Country:US
Mailing Address - Phone:312-912-3171
Mailing Address - Fax:
Practice Address - Street 1:5307 W 79TH ST
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:IL
Practice Address - Zip Code:60459-1403
Practice Address - Country:US
Practice Address - Phone:708-424-5650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-25
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.032205122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist