Provider Demographics
NPI:1073176368
Name:KHAVANDGAR, ZOHREH (DDS)
Entity Type:Individual
Prefix:DR
First Name:ZOHREH
Middle Name:
Last Name:KHAVANDGAR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3083 HERSCHEL AVE APT 215
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-2060
Mailing Address - Country:US
Mailing Address - Phone:469-781-7289
Mailing Address - Fax:
Practice Address - Street 1:5334 N TARRANT PKWY
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-6293
Practice Address - Country:US
Practice Address - Phone:817-581-3411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-22
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34770122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist