Healthcare Provider Details

I. General information

NPI: 1902976632
Provider Name (Legal Business Name): ASRARI ENDODONTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3303 S LINDSAY RD SUITE #106
GILBERT AZ
85296
US

IV. Provider business mailing address

3303 S LINDSAY RD SUITE #106
GILBERT AZ
85296
US

V. Phone/Fax

Practice location:
  • Phone: 480-855-8800
  • Fax: 480-855-8802
Mailing address:
  • Phone: 480-855-8800
  • Fax: 480-855-8802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberD6158
License Number StateAZ

VIII. Authorized Official

Name: DR. MAHSHID ASRARI
Title or Position: ENDODONTIST
Credential: DDS MS
Phone: 480-855-8800