MEDICARE: AMIRALI BEHDANI

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
1	1223G0001X	General Practice Dentistry	D14904	MN

General Provider Information

NPI Number	:	1649964016
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMIRALI BEHDANI

Provider Business Mailing Address
First Line	:	1325 UTICA AVE S APT 421
Second Line	:
City	:	ST LOUIS PARK
State	:	MN
Zip	:	55416-4596
Country	:	US
Telephone Number	:	980-349-1066
Fax Number	:

Provider Business Practice Location Address
First Line	:	12027 BUSINESS PARK BLVD N
Second Line	:
City	:	CHAMPLIN
State	:	MN
Zip	:	55316-4526
Country	:	US
Telephone Number	:	763-421-7900
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2023
Last Update Date	:	06/07/2023

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Directions to “ AMIRALI BEHDANI ” Practice Location

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