Active NPI
Ahmadreza Khademi
- Dentist
- Commerce City, CO
National Provider Identifier
1306601372
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 00206256
- Practice address
- 4972 E 62ND Ave
Commerce City, CO 80022-3253 - Phone
- (303) 288-4969
- NPI assigned
- Feb 19, 2024
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 00206256 | CO | Primary |
Addresses
Primary practice location
4972 E 62ND Ave
Commerce City, CO 80022-3253
Mailing address
4972 E 62ND Ave
Commerce City, CO 80022-3253
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 00206256 | CO | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1708300800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1745712000000",
"number": "1306601372",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4972 E 62ND AVE",
"city": "COMMERCE CITY",
"state": "CO",
"postal_code": "800223253"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4972 E 62ND AVE",
"city": "COMMERCE CITY",
"state": "CO",
"postal_code": "800223253",
"telephone_number": "303-288-4969"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KHADEMI",
"first_name": "AHMADREZA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-02-19",
"last_updated": "2025-04-27",
"certification_date": "2025-04-27",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CO",
"license": "00206256",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Commerce City, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 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.