Individual
MOHAMMAD TAREQ KHADRA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2675 S ABILENE ST STE 135, AURORA, CO 80014-2363
(401) 225-2455
Mailing address
18530 AMBROSIO CIR, CORONA, CA 92881-3411
(401) 225-2455
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
00205725
CO
1223G0001X
General Practice Dentistry
Primary
109296
CA
Other
Enumeration date
09/14/2023
Last updated
03/06/2025
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