Provider Demographics
NPI:1710625579
Name:AHIR, KHUSHBU
Entity Type:Individual
Prefix:
First Name:KHUSHBU
Middle Name:
Last Name:AHIR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1412 E EL CAMINO DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-3835
Mailing Address - Country:US
Mailing Address - Phone:602-702-8590
Mailing Address - Fax:
Practice Address - Street 1:1245 E SOUTHERN AVE STE 12
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-5138
Practice Address - Country:US
Practice Address - Phone:480-636-9970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-23
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD011347122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist