Individual
BEHNAZ KHODADAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
12712 HEACOCK ST, #4, MORENO VALLEY, CA 92553-3037
(951) 247-7400
Mailing address
16185 LA FORTUNA LN, MORENO VALLEY, CA 92551-2027
(951) 243-6682
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
54158
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D54158
DENTICAL
CA
Enumeration date
11/28/2006
Last updated
07/08/2007
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