Healthcare Provider Details

I. General information

NPI: 1992755524
Provider Name (Legal Business Name): KHASHAYAR KEVIN NESHAT DDS, MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8305 FALLS OF NEUSE RD SUITE 105
RALEIGH NC
27615-3546
US

IV. Provider business mailing address

8305 FALLS OF NEUSE RD SUITE 105
RALEIGH NC
27615-3546
US

V. Phone/Fax

Practice location:
  • Phone: 919-841-1720
  • Fax: 919-841-1725
Mailing address:
  • Phone: 919-841-1720
  • Fax: 919-841-1725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number6503
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: