Provider Demographics
NPI:1114174018
Name:SAMETI, KEVIN KEYVAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:KEYVAN
Last Name:SAMETI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 W. ELDORADO BLVD.
Mailing Address - Street 2:
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77564
Mailing Address - Country:US
Mailing Address - Phone:281-990-8448
Mailing Address - Fax:281-286-5224
Practice Address - Street 1:102 W. ELDORADO BLVD.
Practice Address - Street 2:
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77564
Practice Address - Country:US
Practice Address - Phone:281-990-8448
Practice Address - Fax:281-286-5224
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-21
Last Update Date:2010-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX234201223E0200X
PADS0374481223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics