Provider Demographics
NPI:1871521195
Name:MAZAHERI, MICHAEL A (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:A
Last Name:MAZAHERI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7368 E ADELE CT
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-6124
Mailing Address - Country:US
Mailing Address - Phone:614-975-1330
Mailing Address - Fax:
Practice Address - Street 1:725 W ELLIOT RD
Practice Address - Street 2:#104
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-5301
Practice Address - Country:US
Practice Address - Phone:480-633-1481
Practice Address - Fax:480-633-1483
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD65091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice