Provider Demographics
NPI:1457729113
Name:RAKHRA, KABIR (DDS)
Entity Type:Individual
Prefix:
First Name:KABIR
Middle Name:
Last Name:RAKHRA
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 1:10613 W OLIVE AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85345-7339
Mailing Address - Country:US
Mailing Address - Phone:623-933-2145
Mailing Address - Fax:623-933-2379
Practice Address - Street 1:10613 W OLIVE AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85345-7339
Practice Address - Country:US
Practice Address - Phone:623-933-2145
Practice Address - Fax:623-933-2379
Is Sole Proprietor?:No
Enumeration Date:2015-09-10
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ93141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice