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General NPI Number Information
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NPI Number | 1871981787
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Entity Type | Organization
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Legal Business Name | GUARANTEED DENTAL SOLUTIONS
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Dates
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Enumeration Date | 12/30/2014
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Last Update Date | 12/30/2014
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Provider Practice Location Address
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Address Line | 4530 E RAY RD SUITE 170
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City | PHOENIX
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State | AZ
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Zip | 85044-6094
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Country | US
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Telephone | 480-477-3090
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Fax |
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Provider Business Mailing Address
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Address Line | 4530 E RAY RD SUITE 170
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City | PHOENIX
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State | AZ
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Zip | 85044-6094
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Country | US
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Telephone | 480-477-3090
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Fax |
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Authorized Official
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Title or Position | DENTIST, OWNER
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Name | EHSAN POURSHIRAZI
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Credential | DDS
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Telephone | 480-477-3090
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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 | 8789
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License Number State | AZ
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