Provider Demographics
NPI:1306063797
Name:HAGHIGHAT, KAMRAN (BDS, MS)
Entity type:Individual
Prefix:DR
First Name:KAMRAN
Middle Name:
Last Name:HAGHIGHAT
Suffix:
Gender:M
Credentials:BDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 SW 11TH AVE
Mailing Address - Street 2:1020
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-2125
Mailing Address - Country:US
Mailing Address - Phone:503-224-3853
Mailing Address - Fax:503-226-6832
Practice Address - Street 1:833 SW 11TH AVE
Practice Address - Street 2:1020
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205
Practice Address - Country:US
Practice Address - Phone:503-224-3853
Practice Address - Fax:503-226-6832
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD83971223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics