Amir Ghazavi, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

DN24408 Issued in FL

Practice address

4021 S Florida Ave
Lakeland, FL 33813-1623

Phone

(863) 837-1087

NPI assigned

Aug 23, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Networks

• Freedom Health HMO Network

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.

• Clermont Smiles Dentistry, PA

  • General Practice Dentistry
  • Clermont, FL
  • NPI 1174071500
  NPD (past)

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

{
    "created_epoch": "1534982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633392000000",
    "number": "1831670306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4021 S FLORIDA AVE",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338131623"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4021 S FLORIDA AVE",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338131623",
            "telephone_number": "863-837-1087"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GHAZAVI",
        "first_name": "AMIR",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-08-23",
        "last_updated": "2021-10-05",
        "certification_date": "2021-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN24408",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Benjamin H Ghaly, DMD
• Youssef B Ghaly, M.D.
• Rehan Ghani, DDS
• George Ghareeb, MD
• Varsha Ghayal, MD
• William Theotis Ghee, MD
• Cathy Ghent, MS, LMHC
• Janet Ghent
• Andrew Ghobrial
• Serena Ghodasra, DMD

• Dentist in Lakeland, FL
• Providers in Lakeland, FL by specialty
• Dentist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2021; 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.