Provider Demographics
NPI:1053417261
Name:KHERADPIR, ARDAVAN R (DMD)
Entity type:Individual
Prefix:DR
First Name:ARDAVAN
Middle Name:R
Last Name:KHERADPIR
Suffix:
Gender:
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1903 E FIR AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3862
Mailing Address - Country:US
Mailing Address - Phone:559-226-2722
Mailing Address - Fax:559-226-6989
Practice Address - Street 1:1903 E FIR AVE STE 101
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3862
Practice Address - Country:US
Practice Address - Phone:559-226-2722
Practice Address - Fax:559-226-6989
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA528751223S0112X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery