Healthcare Provider Details

I. General information

NPI: 1053766287
Provider Name (Legal Business Name): DEER VALLEY DENTAL GROUP, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2016
Last Update Date: 06/14/2022
Certification Date: 06/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2805 W AGUA FRIA FWY STE 8A
PHOENIX AZ
85027-3938
US

IV. Provider business mailing address

PO BOX 920050
DALLAS TX
75392-0050
US

V. Phone/Fax

Practice location:
  • Phone: 623-255-3390
  • Fax: 623-900-7330
Mailing address:
  • Phone: 714-845-8890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. FARZAN MOJGANI
Title or Position: OWNER DOCTOR
Credential: DDS
Phone: 623-255-3390