1770637779 NPI number — K. KEVIN NESHAT, DDS, MD, PA

Table of content: (NPI 1770637779)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770637779 NPI number — K. KEVIN NESHAT, DDS, MD, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
K. KEVIN NESHAT, DDS, MD, PA
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:
1770637779
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8305 FALLS OF NEUSE RD
Provider Second Line Business Mailing Address:
SUITE 105
Provider Business Mailing Address City Name:
RALEIGH
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27615-3546
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-841-1720
Provider Business Mailing Address Fax Number:
919-841-1725

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8305 FALLS OF NEUSE RD
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
RALEIGH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27615-3546
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-841-1720
Provider Business Practice Location Address Fax Number:
919-841-1725
Provider Enumeration Date:
01/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
NESHAT
Authorized Official First Name:
KHASHAYAR
Authorized Official Middle Name:
KEVIN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
919-841-1720

Provider Taxonomy Codes

  • Taxonomy code: 261QS0112X , with the licence number:  6503 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2428852 . This is a "MEDICARE ID P10#" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 902AF . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com