Provider Demographics
NPI:1770637779
Name:K. KEVIN NESHAT, DDS, MD, PA
Entity Type:Organization
Organization Name:K. KEVIN NESHAT, DDS, MD, PA
Other - Org Name:NU-IMAGE SURGICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KHASHAYAR
Authorized Official - Middle Name:KEVIN
Authorized Official - Last Name:NESHAT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MD
Authorized Official - Phone:919-841-1720
Mailing Address - Street 1:8305 FALLS OF NEUSE RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-3546
Mailing Address - Country:US
Mailing Address - Phone:919-841-1720
Mailing Address - Fax:919-841-1725
Practice Address - Street 1:8305 FALLS OF NEUSE RD
Practice Address - Street 2:SUITE 105
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-3546
Practice Address - Country:US
Practice Address - Phone:919-841-1720
Practice Address - Fax:919-841-1725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6503261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2428852OtherMEDICARE ID P10#
NC902AFOtherBCBS
NC902AFOtherBCBS
NC2428852OtherMEDICARE ID P10#