Active NPI
Ava Khatibshahidi
- General Practice Dentistry
- Buffalo, NY
National Provider Identifier
1619656998
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 064679
- Practice address
- 462 Grider St
Buffalo, NY 14215-3021 - Phone
- (716) 898-1736
- NPI assigned
- Jul 14, 2023
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 064679 | NY | Primary |
Addresses
Primary practice location
462 Grider St
Buffalo, NY 14215-3021
Mailing address
18 Kenaston GDNS
Unit 1304
North York, ONTARIO M2K3C7
CA
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 |
|---|---|---|---|
| 064679 | NY | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1689292800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1753142400000",
"number": "1619656998",
"addresses": [
{
"country_code": "CA",
"country_name": "Canada",
"address_purpose": "MAILING",
"address_type": "FGN",
"address_1": "18 KENASTON GDNS",
"address_2": "UNIT 1304",
"city": "NORTH YORK",
"state": "ONTARIO",
"postal_code": "M2K3C7"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "462 GRIDER ST",
"city": "BUFFALO",
"state": "NY",
"postal_code": "142153021",
"telephone_number": "716-898-1736"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KHATIBSHAHIDI",
"first_name": "AVA",
"name_prefix": "Mrs.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-07-14",
"last_updated": "2025-07-22",
"certification_date": "2025-07-22",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NY",
"license": "064679",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Buffalo, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 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.