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General NPI Number Information
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NPI Number | 1952474223
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Entity Type | Organization
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Legal Business Name | ADMIRE FAMILY DENTISTRY PC
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Dates
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Enumeration Date | 11/16/2006
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Last Update Date | 09/03/2008
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Provider Practice Location Address
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Address Line | 10505 N 69TH STREET SUITE 900
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City | SCOTTSDALE
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State | AZ
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Zip | 85253
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Country | US
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Telephone | 480-607-6646
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Fax | 480-607-1475
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Provider Business Mailing Address
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Address Line | 10505 N 69TH STREET SUITE 900
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City | SCOTTSDALE
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State | AZ
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Zip | 85253
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Country | US
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Telephone | 480-607-6646
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Fax | 480-607-1475
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. NICK NOZAR MANSOURIAN
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Credential | DDS
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Telephone | 480-607-6646
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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 | AZ4613
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License Number State | AZ
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