Healthcare Provider Details

I. General information

NPI: 1265288740
Provider Name (Legal Business Name): KEYAN BASHIRI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2024
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 GOSNELL XING
STAUNTON VA
24401-6297
US

IV. Provider business mailing address

15 GOSNELL XING
STAUNTON VA
24401-6297
US

V. Phone/Fax

Practice location:
  • Phone: 540-213-2244
  • Fax:
Mailing address:
  • Phone: 540-213-2244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number0401419985
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: