Provider Demographics
NPI:1134529290
Name:BAHARVAND, KEVIN (DMD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:
Last Name:BAHARVAND
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:KEVIN
Other - Middle Name:
Other - Last Name:BAHARVAND
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:PO BOX 860036
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55486-0036
Mailing Address - Country:US
Mailing Address - Phone:214-618-5311
Mailing Address - Fax:
Practice Address - Street 1:4713 HIGHWAY 121 STE 304
Practice Address - Street 2:
Practice Address - City:THE COLONY
Practice Address - State:TX
Practice Address - Zip Code:75056-2901
Practice Address - Country:US
Practice Address - Phone:617-699-2519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-26
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32435122300000X, 1223X0400X
MADN1856667122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist