Provider Demographics
NPI:1003243049
Name:KHOSHVAGHTI, ALIREZA (DDS)
Entity Type:Individual
Prefix:
First Name:ALIREZA
Middle Name:
Last Name:KHOSHVAGHTI
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 1:220 MONTGOMERY ST STE 483
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94104-3410
Mailing Address - Country:US
Mailing Address - Phone:415-398-6344
Mailing Address - Fax:
Practice Address - Street 1:220 MONTGOMERY ST STE 483
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94104-3410
Practice Address - Country:US
Practice Address - Phone:415-398-6344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-04
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15302122300000X
VA15302122300000X
CA60385122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist