Provider Demographics
NPI:1336688704
Name:MOHAGER, KAMYAB (DDS)
Entity Type:Individual
Prefix:DR
First Name:KAMYAB
Middle Name:
Last Name:MOHAGER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 W MINERAL AVE STE 250
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80120-5612
Mailing Address - Country:US
Mailing Address - Phone:720-800-7077
Mailing Address - Fax:
Practice Address - Street 1:1501 W MINERAL AVE STE 250
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-5612
Practice Address - Country:US
Practice Address - Phone:720-800-7077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-18
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS102765122300000X
CODEN.002034691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist