Provider Demographics
NPI:1972826642
Name:KAYMANESH, SHAGHAYEGH (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHAGHAYEGH
Middle Name:
Last Name:KAYMANESH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14346 WARWICK BLVD
Mailing Address - Street 2:#420
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23602-3814
Mailing Address - Country:US
Mailing Address - Phone:757-886-2096
Mailing Address - Fax:757-886-2097
Practice Address - Street 1:14346 WARWICK BLVD
Practice Address - Street 2:#420
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602-3814
Practice Address - Country:US
Practice Address - Phone:757-886-2096
Practice Address - Fax:757-886-2097
Is Sole Proprietor?:No
Enumeration Date:2010-03-09
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014127391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice