Provider Demographics
NPI:1386657351
Name:KHORSAND, ARASH (DMD)
Entity Type:Individual
Prefix:
First Name:ARASH
Middle Name:
Last Name:KHORSAND
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52736122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist