Provider Demographics
NPI:1245243229
Name:KHORSAND DMD INC
Entity Type:Organization
Organization Name:KHORSAND DMD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ARASH
Authorized Official - Middle Name:
Authorized Official - Last Name:KHORSAND
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:760-339-9992
Mailing Address - Street 1:646 W MAIN ST
Mailing Address - Street 2:STE #A
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243
Mailing Address - Country:US
Mailing Address - Phone:760-339-9992
Mailing Address - Fax:760-353-3635
Practice Address - Street 1:646 W MAIN ST
Practice Address - Street 2:STE #A
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243
Practice Address - Country:US
Practice Address - Phone:760-339-9992
Practice Address - Fax:760-353-3635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG9379701OtherDENTI CAL PROGRAM STATE O