Healthcare Provider Details

I. General information

NPI: 1578659736
Provider Name (Legal Business Name): REZA ABEDI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

879 N PLAZA DR E014
APACHE JUNCTION AZ
85220-4152
US

IV. Provider business mailing address

879 N PLAZA DR E101
APACHE JUNCTION AZ
85220-4152
US

V. Phone/Fax

Practice location:
  • Phone: 480-288-5955
  • Fax: 480-288-4345
Mailing address:
  • Phone: 480-288-5955
  • Fax: 480-288-4345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: