Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Omid Khaksarfard

Individual provider General Practice Dentistry · NPI 1780403477

Omid Khaksarfard is a General Practice Dentistry in Mt Pleasant, Wisconsin. Practices as a sole proprietor. Licensed in Wisconsin.

Licensed in
WI
In the registry since
2024

Practice location Address checks out

6035 Durand Ave
Mt Pleasant, WI 53406-5049
Phone: (262) 270-6933
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

General Practice Dentistry (primary) Taxonomy 1223G0001X · Licence 6001855 (WI)

Record details

NPI number1780403477
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedOctober 9, 2024
Last updated in NPPESOctober 5, 2025
Certification dateOctober 5, 2025
Mailing address233 Lake Ave Apt 228, Racine, WI 53403-1045

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