Healthcare Provider Details

I. General information

NPI: 1821524398
Provider Name (Legal Business Name): ARASH KHOSHNEVISZADEH DMD, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2017
Last Update Date: 12/03/2020
Certification Date: 12/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32316 5 MILE RD
LIVONIA MI
48154-6109
US

IV. Provider business mailing address

100 RIVERFRONT DR APT 1203
DETROIT MI
48226-4538
US

V. Phone/Fax

Practice location:
  • Phone: 734-523-8300
  • Fax:
Mailing address:
  • Phone: 630-946-4651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number2901600594
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: