Provider Demographics
NPI:1669677852
Name:KHOSHKHOU, MAHTAB (DDS)
Entity Type:Individual
Prefix:
First Name:MAHTAB
Middle Name:
Last Name:KHOSHKHOU
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8531 VETERANS HWY STE 103
Mailing Address - Street 2:
Mailing Address - City:MILLERSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21108-2653
Mailing Address - Country:US
Mailing Address - Phone:410-987-2273
Mailing Address - Fax:443-782-0367
Practice Address - Street 1:8531 VETERANS HWY STE 103
Practice Address - Street 2:
Practice Address - City:MILLERSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21108-2653
Practice Address - Country:US
Practice Address - Phone:410-987-2273
Practice Address - Fax:443-782-0367
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD137501223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry