1730307059 NPI number — GHASEM K. DARIAN, D.D.S., LTD

Table of content: (NPI 1730307059)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730307059 NPI number — GHASEM K. DARIAN, D.D.S., LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GHASEM K. DARIAN, D.D.S., LTD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730307059
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4001 E BELL ROAD
Provider Second Line Business Mailing Address:
STE 120
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85032
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-992-5600
Provider Business Mailing Address Fax Number:
602-992-2442

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4001 E BELL ROAD
Provider Second Line Business Practice Location Address:
STE 120
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85032
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-992-5600
Provider Business Practice Location Address Fax Number:
602-992-2442
Provider Enumeration Date:
04/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SHORTS
Authorized Official First Name:
PAM
Authorized Official Middle Name:
D
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
602-992-5600

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  4354 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 416992 . This is a "AHCCCS" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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