Provider Demographics
NPI:1164898862
Name:NAVID RAHIMPOUR DDS PC
Entity Type:Organization
Organization Name:NAVID RAHIMPOUR DDS PC
Other - Org Name:SOUTHERN CROSS DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, P.C.
Authorized Official - Prefix:MR
Authorized Official - First Name:NAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:RAHIMPOUR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:719-471-1717
Mailing Address - Street 1:1855 S. NEVADA AVENUE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80905-2516
Mailing Address - Country:US
Mailing Address - Phone:719-471-1717
Mailing Address - Fax:719-447-0605
Practice Address - Street 1:1855 S. NEVADA AVENUE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80905-2516
Practice Address - Country:US
Practice Address - Phone:719-471-1717
Practice Address - Fax:719-447-0605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-17
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO77911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty