Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 2901021662 | MI |
NPI | 1053655472 |
---|---|
Provider Name | Dr. Navid Rashidi Keikanloo |
First Address | Syracuse, NY 13208-3216 |
Second Address | Syracuse, NY 13208 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/11/2012 |
Last Update Date | 06/09/2018 |