Provider Demographics
NPI:1265117725
Name:K. KEVIN NESHAT, DDS, MD, PA
Entity type:Organization
Organization Name:K. KEVIN NESHAT, DDS, MD, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF RCM
Authorized Official - Prefix:
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOHNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:984-308-0506
Mailing Address - Street 1:610 DR CALVIN JONES HWY STE 100
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-3104
Mailing Address - Country:US
Mailing Address - Phone:919-336-5230
Mailing Address - Fax:
Practice Address - Street 1:610 DR CALVIN JONES HWY STE 100
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-3104
Practice Address - Country:US
Practice Address - Phone:919-336-5230
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-21
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty