Healthcare Provider Details

I. General information

NPI: 1295878486
Provider Name (Legal Business Name): MASOUD HEKMATYAR D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1847 MONMOUTH ST # A
NEWPORT KY
41071-2637
US

IV. Provider business mailing address

1847 MONMOUTH ST # A
NEWPORT KY
41071-2637
US

V. Phone/Fax

Practice location:
  • Phone: 859-581-7678
  • Fax: 859-581-2624
Mailing address:
  • Phone: 859-581-7678
  • Fax: 859-581-2624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7081
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: