Provider Demographics
NPI:1215328513
Name:KHODARI, HILLARY ROSEN (DMD)
Entity type:Individual
Prefix:
First Name:HILLARY
Middle Name:ROSEN
Last Name:KHODARI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:HILLARY
Other - Middle Name:BETH
Other - Last Name:ROSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:2455 ROUTE 516
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-1892
Mailing Address - Country:US
Mailing Address - Phone:732-679-2323
Mailing Address - Fax:732-679-8896
Practice Address - Street 1:2455 ROUTE 516
Practice Address - Street 2:
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857
Practice Address - Country:US
Practice Address - Phone:732-679-2323
Practice Address - Fax:732-679-8896
Is Sole Proprietor?:No
Enumeration Date:2015-02-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI026825001223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry