Healthcare Provider Details

I. General information

NPI: 1407341035
Provider Name (Legal Business Name): DR. BEHROD KHANKHANIAN DMD, A DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2018
Last Update Date: 10/21/2022
Certification Date: 10/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9643 BURBERRY WAY
HIGHLANDS RANCH CO
80129-6254
US

IV. Provider business mailing address

9643 BURBERRY WAY
HIGHLANDS RANCH CO
80129-6254
US

V. Phone/Fax

Practice location:
  • Phone: 720-233-6812
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number63223
License Number StateCA

VIII. Authorized Official

Name: DR. BEHROD KHANKHANIAN
Title or Position: OWNER
Credential: DMD
Phone: 720-233-6812