1891117974 NPI number — DR. CAMERON KHAVARI PLLC

Table of content: DR. JOHN RYAN BLANKENSHIP DMD (NPI 1760828834)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891117974 NPI number — DR. CAMERON KHAVARI PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR. CAMERON KHAVARI PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1891117974
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/18/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4001 E MOUNTAIN SKY AVE STE 101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85044-3743
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-619-2020
Provider Business Mailing Address Fax Number:
480-436-5800

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4001 E MOUNTAIN SKY AVE STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85044
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-619-2020
Provider Business Practice Location Address Fax Number:
480-436-5800
Provider Enumeration Date:
01/09/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KHAVARIMANESH
Authorized Official First Name:
CAMERON
Authorized Official Middle Name:
REZA
Authorized Official Title or Position:
CHIROPRACTIC PHYSICIAN
Authorized Official Telephone Number:
480-619-2020

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  8116 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)