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General NPI Number Information
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NPI Number | 1376293506
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Entity Type | Individual
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Provider Name | DR. NADIMA KHODOR
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Gender | Female
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Dates
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Enumeration Date | 03/29/2022
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Last Update Date | 08/25/2025
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Provider Practice Location Address
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Address Line | 1290 SALEM RD SW STE 10
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City | ROCHESTER
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State | MN
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Zip | 55902-4210
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Country | US
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Telephone | 469-915-8404
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Fax |
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Provider Business Mailing Address
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Address Line | 412 3RD AVE SE APT 614
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City | ROCHESTER
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State | MN
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Zip | 55904-6947
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Country | US
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Telephone | 469-915-8404
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 10724
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | S246
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License Number State | MN
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