Provider Demographics
NPI:1295079747
Name:DEHGHAN, AMIR (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:AMIR
Middle Name:
Last Name:DEHGHAN
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 N URSULA ST UNIT 401
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80045-7423
Mailing Address - Country:US
Mailing Address - Phone:310-710-6527
Mailing Address - Fax:
Practice Address - Street 1:2101 N URSULA ST UNIT 401
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-7423
Practice Address - Country:US
Practice Address - Phone:310-710-6527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-22
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA610941223X0400X
CO00201888122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist