Healthcare Provider Details

I. General information

NPI: 1689565921
Provider Name (Legal Business Name): ZIAD MOUGHARBEL
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2025
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5835 E STILL CIR
MESA AZ
85206-3618
US

IV. Provider business mailing address

32255 N GARNET WAY
SAN TAN VALLEY AZ
85143-6808
US

V. Phone/Fax

Practice location:
  • Phone: 480-248-8100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberH009376
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: