Provider Demographics
NPI:1477589604
Name:MANSHADI, DAVOOD (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVOOD
Middle Name:
Last Name:MANSHADI
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 1:16107 E NASSAU DR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80013-2725
Mailing Address - Country:US
Mailing Address - Phone:720-840-8106
Mailing Address - Fax:303-341-5447
Practice Address - Street 1:15159 EAST COLFAX AVE.
Practice Address - Street 2:#B
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011
Practice Address - Country:US
Practice Address - Phone:303-341-5437
Practice Address - Fax:303-341-5447
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO81511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
1750783OtherUNITED CONCORDIA ID #
CO14557886Medicaid