Provider Demographics
NPI:1033638093
Name:KHOSHKAM, VAHID (DDS,MS)
Entity Type:Individual
Prefix:DR
First Name:VAHID
Middle Name:
Last Name:KHOSHKAM
Suffix:
Gender:M
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 BOB HOPE DR APT 612
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-1630
Mailing Address - Country:US
Mailing Address - Phone:510-705-2412
Mailing Address - Fax:
Practice Address - Street 1:5929 CROMO DR STE B
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-5579
Practice Address - Country:US
Practice Address - Phone:915-581-6688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX335141223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics