Provider Demographics
NPI:1386911857
Name:KHANJARI, HAMID (DDS)
Entity type:Individual
Prefix:DR
First Name:HAMID
Middle Name:
Last Name:KHANJARI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 S MONACO ST
Mailing Address - Street 2:APT 231
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-3446
Mailing Address - Country:US
Mailing Address - Phone:952-451-1188
Mailing Address - Fax:
Practice Address - Street 1:1100 S COLORADO BLVD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CO
Practice Address - Zip Code:80246-3003
Practice Address - Country:US
Practice Address - Phone:303-758-0575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-28
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO104831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice