Healthcare Provider Details

I. General information

NPI: 1811220197
Provider Name (Legal Business Name): BEHNAM KAMVARI D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2009
Last Update Date: 09/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10566 N HIGHWAY 191
ELFRIDA AZ
85610-9021
US

IV. Provider business mailing address

1205 F AVE
DOUGLAS AZ
85607-1920
US

V. Phone/Fax

Practice location:
  • Phone: 520-642-2222
  • Fax: 520-364-4261
Mailing address:
  • Phone: 520-364-1429
  • Fax: 520-364-4261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7893
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: