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General NPI Number Information
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NPI Number | 1467485599
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Entity Type | Individual
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Provider Name | VISHTASB BROUMAND DMD MD
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Gender | Male
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Dates
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Enumeration Date | 07/09/2006
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Last Update Date | 06/18/2025
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Provider Practice Location Address
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Address Line | 13400 E SHEA BLVD
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City | SCOTTSDALE
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State | AZ
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Zip | 85259-5452
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Country | US
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Telephone | 480-301-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 20950 N TATUM BLVD STE 200
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City | PHOENIX
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State | AZ
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Zip | 85050-4269
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Country | US
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Telephone | 480-284-8087
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Fax | 480-659-6098
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | D008845
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DN14533
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | D008845
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License Number State | AZ
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