Provider Demographics
NPI:1760354807
Name:DISTINCTIVE DENTAL CARE OF BLOOMINGDALE
Entity type:Organization
Organization Name:DISTINCTIVE DENTAL CARE OF BLOOMINGDALE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HUSNA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-751-9716
Mailing Address - Street 1:1 TIFFANY PT STE 205
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-2916
Mailing Address - Country:US
Mailing Address - Phone:630-359-0105
Mailing Address - Fax:630-523-9105
Practice Address - Street 1:1 TIFFANY PT STE 205
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-2916
Practice Address - Country:US
Practice Address - Phone:630-359-0105
Practice Address - Fax:630-523-9105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-18
Last Update Date:2025-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental