Provider Demographics
NPI:1295250231
Name:TALEBPOUR, KAZHALL (DDS)
Entity type:Individual
Prefix:DR
First Name:KAZHALL
Middle Name:
Last Name:TALEBPOUR
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 1:10650 GARDEN DR UNIT 106
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-7019
Mailing Address - Country:US
Mailing Address - Phone:646-749-8058
Mailing Address - Fax:
Practice Address - Street 1:10650 GARDEN DR STE UNIT106
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-7018
Practice Address - Country:US
Practice Address - Phone:303-366-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-10
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO002032841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CODEN.00203284OtherCOLORADO DEPARTMENT OF REGULATORY AGENCIES