Provider Demographics
NPI:1063848331
Name:FAVERO, KHOURSCHID A (DMD)
Entity Type:Individual
Prefix:DR
First Name:KHOURSCHID
Middle Name:A
Last Name:FAVERO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:KHOURSCHID
Other - Middle Name:A
Other - Last Name:NAIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:3201 TEASLEY LN STE 101
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76210-8301
Mailing Address - Country:US
Mailing Address - Phone:940-566-2847
Mailing Address - Fax:
Practice Address - Street 1:3201 TEASLEY LN STE 101
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-8301
Practice Address - Country:US
Practice Address - Phone:940-566-2847
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-18
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013034505122300000X
CA63302122300000X
TX382501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist