Provider Demographics
NPI:1790303774
Name:KHIZIRPOUR, WED (DDS)
Entity Type:Individual
Prefix:DR
First Name:WED
Middle Name:
Last Name:KHIZIRPOUR
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 1:1617 NE 77TH TER
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64118-1940
Mailing Address - Country:US
Mailing Address - Phone:816-824-8933
Mailing Address - Fax:
Practice Address - Street 1:1680 NW CHIPMAN RD
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64081-3934
Practice Address - Country:US
Practice Address - Phone:816-600-3722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-07
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20200185731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice