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General NPI Number Information
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NPI Number | 1538720024
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Entity Type | Individual
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Provider Name | PARSA OWTAD DMD
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Gender | Male
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Dates
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Enumeration Date | 06/25/2019
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Last Update Date | 06/25/2019
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Provider Practice Location Address
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Address Line | 13660 N 94TH DR STE E3
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City | PEORIA
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State | AZ
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Zip | 85381-4209
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Country | US
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Telephone | 623-974-4799
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Fax |
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Provider Business Mailing Address
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Address Line | 6975 E PRINCESS DR APT 3049
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City | PHOENIX
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State | AZ
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Zip | 85054-4231
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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 |
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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 | D010389
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License Number State | AZ
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