Provider Demographics
NPI:1811220197
Name:KAMVARI, BEHNAM (DMD)
Entity Type:Individual
Prefix:DR
First Name:BEHNAM
Middle Name:
Last Name:KAMVARI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 F AVE
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:AZ
Mailing Address - Zip Code:85607-1920
Mailing Address - Country:US
Mailing Address - Phone:520-364-1429
Mailing Address - Fax:520-364-4261
Practice Address - Street 1:10566 N HIGHWAY 191
Practice Address - Street 2:
Practice Address - City:ELFRIDA
Practice Address - State:AZ
Practice Address - Zip Code:85610-9021
Practice Address - Country:US
Practice Address - Phone:520-642-2222
Practice Address - Fax:520-364-4261
Is Sole Proprietor?:No
Enumeration Date:2009-09-17
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ78931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ468656Medicaid