Keyvan Tavakoli, D.D.S.

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

22487 Issued in FL

Practice address

18964 N Dale Mabry Hwy Ste 103
Lutz, FL 33548-4913

Phone

(813) 591-1568

NPI assigned

Oct 16, 2012

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 5

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Keyvan Tavakoli, DDS, MDS, P.a.

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Lutz, FL
  • NPI 1003345802
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1350345600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1285987206",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18964 N DALE MABRY HWY STE 103",
            "city": "LUTZ",
            "state": "FL",
            "postal_code": "335484913",
            "telephone_number": "813-591-1568"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18964 N DALE MABRY HWY STE 103",
            "city": "LUTZ",
            "state": "FL",
            "postal_code": "335484913",
            "telephone_number": "813-591-1568"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "36977 Park Ave",
            "address_purpose": "LOCATION",
            "city": "Burney",
            "state": "CA",
            "postal_code": "960134067",
            "country_code": "US",
            "telephone_number": "530-335-3651",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "18990 S Tamiami Trl # 110",
            "address_purpose": "LOCATION",
            "city": "Fort Myers",
            "state": "FL",
            "postal_code": "339084737",
            "country_code": "US",
            "telephone_number": "239-482-2296",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4161 Tamiami Trl Ste 604",
            "address_purpose": "LOCATION",
            "city": "Port Charlotte",
            "state": "FL",
            "postal_code": "339529283",
            "country_code": "US",
            "telephone_number": "941-255-8500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TAVAKOLI",
        "first_name": "KEYVAN",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-10-16",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NY",
            "license": "056001",
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "CA",
            "license": "100032",
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "TX",
            "license": "32856",
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "NC",
            "license": "10615",
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "FL",
            "license": "22487",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "056001",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tampa Orthopedic Clinic,LLP
• Tampa Physicians Alliance Corp
• Tampa Pulmonary and Sleep Institute, LLC.
• Paola Ines Tapia Camacho
• Mike S Tarjoman, D.C.
• Teca Medical Enterprises Corp
• Eric D Teeman, DPM
• Carolyne Teixeira
• Jennifer Teixeira, APRN
• Sydney Tenney

• Orthodontics and Dentofacial Orthopedics Dentistry in Lutz, FL
• Providers in Lutz, FL by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.