Mehran Khanbabapour

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D010351 Issued in AZ

Practice address

2755 S 99TH Ave Ste 105
Tolleson, AZ 85353-1404

Phone

(623) 478-1624

NPI assigned

Oct 20, 2015

Last updated

Jul 30, 2019By the provider in NPPES

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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

• Promenade Dental Group, LLP

  dba Promenade Dental Group

  • General Practice Dentistry
  • Tolleson, AZ
  • NPI 1285798462
  NPD (past)

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

{
    "created_epoch": "1445299200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1564444800000",
    "number": "1023480860",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6975 E PRINCESS DR APT 3120",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850544234",
            "telephone_number": "310-991-5234"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2755 S 99TH AVE STE 105",
            "city": "TOLLESON",
            "state": "AZ",
            "postal_code": "853531404",
            "telephone_number": "623-478-1624"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6958 Nebraska Ave",
            "address_2": "Building 1608",
            "address_purpose": "LOCATION",
            "city": "Fort Leonard Wood",
            "state": "MO",
            "postal_code": "654731618",
            "country_code": "US",
            "telephone_number": "573-596-0364",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KHANBABAPOUR",
        "first_name": "MEHRAN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-10-20",
        "last_updated": "2019-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MO",
            "license": "2015021512",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AZ",
            "license": "D010351",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Grace Keishanyu
• Christine M Kemboi
• Kena Transportation LLC
• Tiffany Kennedy
• Asiya Kenyatta
• Neda Rezaei Khorrami
• Mamaleh Kiandoli
• Kassinda King Bayo
• Kingdom Women LLC (Precious Jewels Home Care)
• Mandy Ba Kitamura, PHARMD

• General Practice Dentistry in Tolleson, AZ
• Providers in Tolleson, AZ by specialty
• General Practice Dentistry in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2019; 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.