=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265243828
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHANDLER DENTAL HOME
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/14/2025
-----------------------------------------------------
Last Update Date | 01/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4055 S ARIZONA AVE STE 7
-----------------------------------------------------
City | CHANDLER
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85248-4587
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-680-0981
-----------------------------------------------------
Fax | 480-690-5793
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4055 S ARIZONA AVE STE 7
-----------------------------------------------------
City | CHANDLER
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85248-4587
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-680-0981
-----------------------------------------------------
Fax | 480-690-5793
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. ALHARETH DHARI
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 716-430-5757
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------