Provider Demographics
NPI:1073069894
Name:KALANTARPOUR, NAVID
Entity type:Individual
Prefix:DR
First Name:NAVID
Middle Name:
Last Name:KALANTARPOUR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1607 SE 92ND CT
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98664
Mailing Address - Country:US
Mailing Address - Phone:360-449-2298
Mailing Address - Fax:
Practice Address - Street 1:12239 N CENTER AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97217-7806
Practice Address - Country:US
Practice Address - Phone:503-241-1800
Practice Address - Fax:503-241-1807
Is Sole Proprietor?:No
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD10512122300000X
WADE60658420122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist