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General NPI Number Information
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NPI Number | 1326037250
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Entity Type | Individual
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Provider Name | MANDANA KHESHTCHIN D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 10/13/2005
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Last Update Date | 11/04/2019
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Provider Practice Location Address
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Address Line | 2626 S RURAL RD
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City | TEMPE
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State | AZ
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Zip | 85282-2431
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Country | US
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Telephone | 480-597-4163
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Fax |
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Provider Business Mailing Address
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Address Line | 960 W UNIVERSITY DR SUITE 115
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City | TEMPE
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State | AZ
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Zip | 85281-7808
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Country | US
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Telephone | 480-921-3811
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Fax | 480-921-3830
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 5191
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License Number State | AZ
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