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NPI Code Detail

MEDICARE: DR. ZOHREH KHAVANDGAR DDS

MEDICARE:  DR. ZOHREH  KHAVANDGAR  DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist34770TX

General Provider Information

NPI Number : 1073176368
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ZOHREH KHAVANDGAR DDS
Provider Business Mailing Address
First Line : 3083 HERSCHEL AVE APT 215
Second Line :
City : DALLAS
State : TX
Zip : 75219-2060
Country : US
Telephone Number : 469-781-7289
Fax Number :
Provider Business Practice Location Address
First Line : 5334 N TARRANT PKWY
Second Line :
City : FORT WORTH
State : TX
Zip : 76244-6293
Country : US
Telephone Number : 817-581-3411
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/22/2019
Last Update Date : 04/22/2019

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Directions to “ DR. ZOHREH KHAVANDGAR DDS” Practice Location

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