Provider Demographics
NPI:1134544281
Name:HOSSEINI, KEVAN (DMD)
Entity type:Individual
Prefix:
First Name:KEVAN
Middle Name:
Last Name:HOSSEINI
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 1:8 CRESTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:PA
Mailing Address - Zip Code:18612-9114
Mailing Address - Country:US
Mailing Address - Phone:570-704-9818
Mailing Address - Fax:
Practice Address - Street 1:401 E 34TH ST APT S19M
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6699
Practice Address - Country:US
Practice Address - Phone:570-704-9818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-26
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0579411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice