Provider Demographics
NPI:1629849088
Name:K. KEVIN NESHAT, DDS, MD, PA
Entity Type:Organization
Organization Name:K. KEVIN NESHAT, DDS, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF RCM
Authorized Official - Prefix:
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOHNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:984-308-0506
Mailing Address - Street 1:3200 WENDELL BLVD
Mailing Address - Street 2:
Mailing Address - City:WENDELL
Mailing Address - State:NC
Mailing Address - Zip Code:27591-5908
Mailing Address - Country:US
Mailing Address - Phone:919-365-3127
Mailing Address - Fax:
Practice Address - Street 1:3200 WENDELL BLVD
Practice Address - Street 2:
Practice Address - City:WENDELL
Practice Address - State:NC
Practice Address - Zip Code:27591-5908
Practice Address - Country:US
Practice Address - Phone:919-365-3127
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:K. KEVIN NESHAT, DDS, MD, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty