IndividualActive
Omid Khaksarfard
NPI 1780403477 · General Practice Dentistry · Mt Pleasant, WI
Omid Khaksarfard is a General Practice Dentistry provider in Mt Pleasant, WI (NPI 1780403477).
Provider details
- NPI number
- 1780403477
- Entity type
- Individual
- Primary specialty
- General Practice DentistryDental Providers
- Sex
- Male
- Sole proprietor
- Yes
- License
- 6001855 (WI)
Practice location
6035 Durand Ave
Mt Pleasant, WI 53406-5049
Phone: (262) 270-6933
Street-level locationGet directions
Mailing address
233 Lake Ave Apt 228
Racine, WI 53403-1045
Registry dates
- Enumerated
- 2024-10-09
- Last updated
- 2025-10-05
- Certified
- 2025-10-05
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.