Provider Demographics
NPI:1235213992
Name:DAVANI, REZA HASHEMI (DDS)
Entity Type:Individual
Prefix:
First Name:REZA
Middle Name:HASHEMI
Last Name:DAVANI
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 1:3506 W TYVOLA RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28208-7201
Mailing Address - Country:US
Mailing Address - Phone:704-329-1300
Mailing Address - Fax:704-357-7523
Practice Address - Street 1:3053 FREEDOM DR STE B
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28208-3862
Practice Address - Country:US
Practice Address - Phone:704-393-3911
Practice Address - Fax:704-392-1096
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX216601223G0001X
NC00581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
1675597OtherUNITED CONCORDIA
NC5905747Medicaid
903AXOtherBLUE CROSS BLUE SHIELD NC