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General NPI Number Information
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NPI Number | 1174666275
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Entity Type | Organization
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Legal Business Name | MY ORTHODONTIST, PC
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Dates
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Enumeration Date | 02/15/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2765 S MARKET ST SUITE 103
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City | GILBERT
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State | AZ
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Zip | 85296-6305
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Country | US
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Telephone | 480-857-9500
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Fax | 480-857-9502
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Provider Business Mailing Address
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Address Line | 902 E MOUNTAIN SAGE DR
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City | PHOENIX
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State | AZ
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Zip | 85048-4430
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Country | US
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Telephone | 602-573-1086
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SALMAN JAFFER
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Credential | D.M.D., M.P.H.
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Telephone | 602-573-1086
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | D7070
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License Number State | AZ
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