NPIMap

Organization Active NPI

Kawveh Nofallah DMD PA

  • General Practice Dentistry
  • Lakeland, FL
National Provider Identifier
1851479265
Registry record updated Sep 18, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DN 17075 Issued in FL
Legal business name
KAWVEH NOFALLAH DMD PA
Practice address
3624 Harden Blvd
Lakeland, FL 33803-5938
Phone
(863) 648-5338
Fax
(863) 648-5890
NPI assigned
Nov 2, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2008

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

Authorized official

Name
Dr. Kawveh Nofallah, DMDNPI 1417381518
Title
Owner-Dentist
Phone
(863) 648-5338

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X DN 17075 FL Primary

Addresses

Primary practice location

3624 Harden Blvd
Lakeland, FL 33803-5938

Mailing address

3624 Harden Blvd
Lakeland, FL 33803-5938
Phone (863) 648-5338

National Provider Directory

National Provider Directory

Locations

3624 Harden Blvd
Lakeland, FL 33803
Phone (863) 648-5338

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1162425600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1221696000000",
    "number": "1851479265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3624 HARDEN BLVD",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338035938",
            "telephone_number": "863-648-5338",
            "fax_number": "863-648-5890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3624 HARDEN BLVD",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338035938",
            "telephone_number": "863-648-5338",
            "fax_number": "863-648-5890"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KAWVEH NOFALLAH DMD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-02",
        "last_updated": "2008-09-18",
        "status": "A",
        "authorized_official_last_name": "NOFALLAH",
        "authorized_official_first_name": "KAWVEH",
        "authorized_official_title_or_position": "OWNER-DENTIST",
        "authorized_official_telephone_number": "863-648-5338",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN 17075",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakeland, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.