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Active NPI 1598505083 Individual Practitioner Male Practitioner

Dr. Khashayar Khodadoustan , DDS

Dentist - General Practice • Glencoe, MN

Professional Overview & Biography Verified Profile Summary

Dr. Khashayar Khodadoustan, DDS is a registered healthcare professional specializing in Dentist - General Practice in Glencoe, MN. Practice services are available at 1126 IVES AVE N under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

1126 Ives Ave N

Glencoe, MN 553362226

Telephone 3208643215
Fax 3208642768
Associated Practice Facility / Clinic
🏢 Gwen Regnier Dmd Pllc Facility NPI 1821604935

Specialty Benchmarks & Practice Insights

Comparative analytics for Dentist - General Practice in Glencoe, MN

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 33.3 Yrs
Regional Practice Density
7 Specialists

Practicing in Glencoe, MN (2262 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

CMS Verified: 2024-05-30
Dentist - General Practice Primary Specialty

NUCC Taxonomy Code: 1223G0001X

State License MN D15073

A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

4 Associated Practitioners
Dr. Brent Olson , DDS

Dentist - General Practice

NPI 1437275013

Doctor of Dental Surgery

Dr. Gwen Regnier , DMD

Dentist - General Practice

NPI 1568815298

Doctor of Dental Medicine

Dr. William Dunbar , DDS

Dentist - General Practice

NPI 1598839508

Doctor of Dental Surgery

Sheri Trif , RDH, MSDT

Dental Therapist

NPI 1730531906

Registered Dental Hygienist, MSDT

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

6 Historical Events
NPI Profile Active May 30, 2024

NPI status registered as active in NPPES database

📍
Updated Practice Location May 30, 2024

Registered at 1126 IVES AVE N, GLENCOE, MN 553362226 (Tel: 3208643215)

📍
Updated Business Mailing Address May 30, 2024

Registered at 1738 PALISADE CIR, EAGAN, MN 551221721 (Tel: 6517570940)

👤
Provider Name / Credentials Updated May 30, 2024

Recorded as KHASHAYAR KHODADOUSTAN, DDS

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) May 30, 2024

Dentist (License #D15073 in MN)

🟢
Initial NPI Registration & Enumeration May 30, 2024

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1598505083
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: May 30, 2024
Last Update: May 30, 2024
Sole Proprietor: No

Mailing Address

1738 Palisade Cir

Eagan, MN 551221721

Phone: 6517570940

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.