Behnam Fakhravar, DMD, MS

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

DE60231686 Issued in WA

Practice address

322 SE 192ND Ave Ste 100
Vancouver, WA 98683-9679

Phone

(219) 360-9587

NPI assigned

Jul 21, 2011

Last updated

Feb 20, 2020By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 5

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

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

Credentials

Master of Science

State licenses

Practice roles

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

• Advantage Dental Group, PC

  dba Advantage Dental Oral Health Center

  • General Practice Dentistry
  • Bend, OR
  • NPI 1972970671

  Multi-Specialty

  NPD (past)

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

{
    "created_epoch": "1311206400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1582156800000",
    "number": "1700164969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "322 SE 192ND AVE STE 100",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986839679",
            "telephone_number": "360-219-9587"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "322 SE 192ND AVE STE 100",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986839679",
            "telephone_number": "219-360-9587"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1440 N Lombard St",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972175533",
            "country_code": "US",
            "telephone_number": "971-302-2127",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2404 Columbia House Blvd",
            "address_purpose": "LOCATION",
            "city": "Vancouver",
            "state": "WA",
            "postal_code": "986617777",
            "country_code": "US",
            "telephone_number": "360-356-1388",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1710 SW 9th Ave Ste 120",
            "address_purpose": "LOCATION",
            "city": "Battle Ground",
            "state": "WA",
            "postal_code": "986043267",
            "country_code": "US",
            "telephone_number": "360-219-9591",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "800 NE Tenney Rd Ste B201",
            "address_purpose": "LOCATION",
            "city": "Vancouver",
            "state": "WA",
            "postal_code": "986852831",
            "country_code": "US",
            "telephone_number": "360-839-2789",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FAKHRAVAR",
        "first_name": "BEHNAM",
        "name_prefix": "Dr.",
        "credential": "DMD, MS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-07-21",
        "last_updated": "2020-02-20",
        "certification_date": "2020-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "CA",
            "license": "DDS61887",
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "WI",
            "license": "1001779",
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "TX",
            "license": "28573",
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "OR",
            "license": "D9565",
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "WA",
            "license": "DE60231686",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ashley Faiola
• Fait (Arianna.Kee, LMHC, SUDP)
• Jill Yoshiko Yuzuriha Fajardo, O.D.
• Michelle Elizabeth Fajer, LMT
• Falon Fakess, LPN
• Caleb Falconer, RND
• Jamie Scott Falconer, REGISTERED NURSE
• Brandon Dean Falls
• Cindy S Falter
• Family Care Services, Inc

• Periodontics in Vancouver, WA
• Providers in Vancouver, WA by specialty
• Periodontics in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2020; 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.