Provider Demographics
NPI:1497130256
Name:SADR ESHKEVARI, POOYAN (MD, DDS)
Entity Type:Individual
Prefix:
First Name:POOYAN
Middle Name:
Last Name:SADR ESHKEVARI
Suffix:
Gender:M
Credentials:MD, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1370 S COUNTY TRL LOWR LEVEL
Mailing Address - Street 2:
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-1625
Mailing Address - Country:US
Mailing Address - Phone:401-885-1450
Mailing Address - Fax:401-885-8570
Practice Address - Street 1:1370 S COUNTY TRL LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-1625
Practice Address - Country:US
Practice Address - Phone:401-885-1450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-22
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDEN036521223S0112X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery