Mohammad Tareq Khadra, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

109296 Issued in CA

Practice address

2675 S Abilene St Ste 135
Aurora, CO 80014-2363

Phone

(401) 225-2455

NPI assigned

Sep 14, 2023

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Tareq Khadra Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Mohammad Tareq Khadra DDS, PLLC

  • Dentist
  • Aurora, CO
  • NPI 1427851252
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1694649600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741219200000",
    "number": "1013794791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18530 AMBROSIO CIR",
            "city": "CORONA",
            "state": "CA",
            "postal_code": "928813411",
            "telephone_number": "401-225-2455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2675 S ABILENE ST STE 135",
            "city": "AURORA",
            "state": "CO",
            "postal_code": "800142363",
            "telephone_number": "401-225-2455"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "18530 Ambrosio Cir",
            "address_purpose": "LOCATION",
            "city": "Corona",
            "state": "CA",
            "postal_code": "928813411",
            "country_code": "US",
            "telephone_number": "401-225-2455",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KHADRA",
        "first_name": "MOHAMMAD TAREQ",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-09-14",
        "last_updated": "2025-03-06",
        "certification_date": "2025-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CO",
            "license": "00205725",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "109296",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TAREQ",
            "last_name": "KHADRA",
            "credential": "DDS",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Keystone Primary Care LLC
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• KG Home Care LLC
• Ferougg Khaaliq, PA
• Nasim Khalfe, MD
• Ameedah Zahirah Khalifeh, MSW
• Anne Khalifeh, PSY.D., ABPP
• Khalorado Dental PLLC
• Gurusewak Khalsa, PHD, LP

• General Practice Dentistry in Aurora, CO
• Providers in Aurora, CO by specialty
• General Practice Dentistry in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.