Provider Demographics
NPI:1487100897
Name:IMENI KASHANI, ERFAN (DDS)
Entity type:Individual
Prefix:
First Name:ERFAN
Middle Name:
Last Name:IMENI KASHANI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7308 HIHENGE CT
Mailing Address - Street 2:APT #8
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-4309
Mailing Address - Country:US
Mailing Address - Phone:336-266-1007
Mailing Address - Fax:
Practice Address - Street 1:6400 CREEDMOOR RD
Practice Address - Street 2:SUITE 103
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27613-4481
Practice Address - Country:US
Practice Address - Phone:919-977-7480
Practice Address - Fax:919-977-7481
Is Sole Proprietor?:No
Enumeration Date:2016-08-27
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC105051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice