Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 23420 | TX |
N | 1223E0200X | Endodontist | DS037448 | PA |
NPI | 1114174018 |
---|---|
Provider Name | Dr. Kevin Keyvan Sameti |
First Address | Friendswood, TX 77564 |
Second Address | Friendswood, TX 77564 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2008 |
Last Update Date | 30/04/2010 |