Healthcare Provider Details

I. General information

NPI: 1144524778
Provider Name (Legal Business Name): MEHRYAR ZIAFAT D.M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2010
Last Update Date: 09/13/2023
Certification Date: 09/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 ANTHONY DR
ANTHONY NM
88021-9179
US

IV. Provider business mailing address

385 CALLE DE ALEGRA
LAS CRUCES NM
88005-3423
US

V. Phone/Fax

Practice location:
  • Phone: 575-882-3607
  • Fax: 575-882-2909
Mailing address:
  • Phone: 575-526-1105
  • Fax: 575-524-4266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number26202
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDD3613
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: