Individual
MEHRAN KHANBABAPOUR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2755 S 99TH AVE STE 105, TOLLESON, AZ 85353-1404
(623) 478-1624
Mailing address
6975 E PRINCESS DR APT 3120, PHOENIX, AZ 85054-4234
(310) 991-5234
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
2015021512
MO
1223G0001X
General Practice Dentistry
Primary
D010351
AZ
Other
Enumeration date
10/20/2015
Last updated
07/30/2019
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