Provider Demographics
NPI:1992755524
Name:NESHAT, KHASHAYAR KEVIN (DDS, MD)
Entity type:Individual
Prefix:DR
First Name:KHASHAYAR
Middle Name:KEVIN
Last Name:NESHAT
Suffix:
Gender:M
Credentials:DDS, MD
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Mailing Address - Street 1:8305 FALLS OF NEUSE RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-3546
Mailing Address - Country:US
Mailing Address - Phone:919-841-1720
Mailing Address - Fax:919-841-1725
Practice Address - Street 1:8305 FALLS OF NEUSE RD
Practice Address - Street 2:SUITE 105
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-3546
Practice Address - Country:US
Practice Address - Phone:919-841-1720
Practice Address - Fax:919-841-1725
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC65031223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCU80668Medicare UPIN