Provider Demographics
NPI:1457783318
Name:KHODAKHAST, AVA BEHESHTEH (DDS)
Entity Type:Individual
Prefix:
First Name:AVA
Middle Name:BEHESHTEH
Last Name:KHODAKHAST
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 1:8120 S HOLLY ST #208
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80122
Mailing Address - Country:US
Mailing Address - Phone:303-770-2254
Mailing Address - Fax:303-770-2285
Practice Address - Street 1:8120 S HOLLY ST STE 208
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80122-4007
Practice Address - Country:US
Practice Address - Phone:720-573-2454
Practice Address - Fax:303-770-2285
Is Sole Proprietor?:No
Enumeration Date:2013-08-02
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.00203770122300000X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist