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General NPI Number Information
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NPI Number | 1114174018
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Entity Type | Individual
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Provider Name | KEVIN KEYVAN SAMETI D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 08/21/2008
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Last Update Date | 04/30/2010
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Provider Practice Location Address
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Address Line | 102 W. ELDORADO BLVD.
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City | FRIENDSWOOD
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State | TX
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Zip | 77564
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Country | US
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Telephone | 281-990-8448
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Fax | 281-286-5224
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Provider Business Mailing Address
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Address Line | 102 W. ELDORADO BLVD.
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City | FRIENDSWOOD
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State | TX
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Zip | 77564
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Country | US
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Telephone | 281-990-8448
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Fax | 281-286-5224
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 23420
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | DS037448
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License Number State | PA
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