Provider Demographics
NPI:1396040127
Name:FATHIMANI, KAYVAN (DDS)
Entity Type:Individual
Prefix:
First Name:KAYVAN
Middle Name:
Last Name:FATHIMANI
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 1:10535 PARK MEADOWS BLVD STE 250
Mailing Address - Street 2:
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-8401
Mailing Address - Country:US
Mailing Address - Phone:303-381-7101
Mailing Address - Fax:
Practice Address - Street 1:10535 PARK MEADOWS BLVD STE 250
Practice Address - Street 2:
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-8401
Practice Address - Country:US
Practice Address - Phone:303-381-7101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-26
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0566591223S0112X
CODEN.002047161223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery