Provider Demographics
NPI:1417354093
Name:ARDESHIR RAGHIAN DDS PC
Entity type:Organization
Organization Name:ARDESHIR RAGHIAN DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ARDESHIR
Authorized Official - Middle Name:
Authorized Official - Last Name:RAGHIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-622-3454
Mailing Address - Street 1:5841 W BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-5201
Mailing Address - Country:US
Mailing Address - Phone:773-622-3454
Mailing Address - Fax:773-622-0990
Practice Address - Street 1:5841 W BELMONT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-5201
Practice Address - Country:US
Practice Address - Phone:773-622-3454
Practice Address - Fax:773-622-0990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-26
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019024426122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty