OMID KHAKSARFARD

MT PLEASANT, WI
NPI1780403477
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy1223G0001X Dentist, General Practice
(Licence: WI  6001855)
Enumeration Date2024-10-09
Last Update Date2025-10-05
Business Address
OMID KHAKSARFARD
6035 DURAND AVE
MT PLEASANT, WI 53406-5049
Phone number: 262-270-6933
Mailing Address
OMID KHAKSARFARD
233 LAKE AVE APT 228
RACINE, WI 53403-1045
Phone number: 571-430-0432
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