Healthcare Provider Details

I. General information

NPI: 1689112187
Provider Name (Legal Business Name): AILAR BAGHERDAEI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2017
Last Update Date: 08/29/2025
Certification Date: 08/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5120 S BROADWAY STE B
ENGLEWOOD CO
80113-9304
US

IV. Provider business mailing address

5120 BROADWAY STE B
DENVER CO
80216-2094
US

V. Phone/Fax

Practice location:
  • Phone: 303-794-0044
  • Fax:
Mailing address:
  • Phone: 303-793-0044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS039513
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDEN.00203254
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: