Provider Demographics
NPI:1184954422
Name:KAMRAN HAGHIGHAT BDS MS PC
Entity type:Organization
Organization Name:KAMRAN HAGHIGHAT BDS MS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAMRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAGHIGHAT
Authorized Official - Suffix:
Authorized Official - Credentials:BDS MS PC
Authorized Official - Phone:503-224-3853
Mailing Address - Street 1:833 SW 11TH AVE STE 1020
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-2124
Mailing Address - Country:US
Mailing Address - Phone:503-224-3853
Mailing Address - Fax:503-226-6832
Practice Address - Street 1:833 SW 11TH AVE STE 1020
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2124
Practice Address - Country:US
Practice Address - Phone:503-224-3853
Practice Address - Fax:503-226-6832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-08
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD83971223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty