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General NPI Number Information
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NPI Number | 1083027197
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Entity Type | Organization
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Legal Business Name | HALEH BAZARGAN DDS PLLC
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Dates
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Enumeration Date | 06/05/2014
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Last Update Date | 06/05/2014
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Provider Practice Location Address
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Address Line | 430 W FINNIE FLAT RD
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City | CAMP VERDE
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State | AZ
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Zip | 86322-7362
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Country | US
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Telephone | 928-567-4108
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Fax |
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Provider Business Mailing Address
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Address Line | 430 W FINNIE FLAT RD
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City | CAMP VERDE
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State | AZ
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Zip | 86322-7362
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | HALEH BAZARGAN
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Credential | DDS
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Telephone | 631-388-0906
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2553
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 8377
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 8563
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License Number State | AZ
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