Individual
DR. KHASHAYAR KHODADOUSTAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1126 IVES AVE N, GLENCOE, MN 55336-2226
(320) 864-3215
(320) 864-2768
Mailing address
1738 PALISADE CIR, EAGAN, MN 55122-1721
(651) 757-0940
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D15073
MN
Other
Enumeration date
05/30/2024
Last updated
05/30/2024
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