=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952831240
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANDRE ZARGAR DMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/19/2017
-----------------------------------------------------
Last Update Date | 03/17/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9897 W MCDOWELL RD STE 745
-----------------------------------------------------
City | TOLLESON
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85353-1634
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-478-7788
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10800 E CACTUS RD UNIT 41
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85259-2505
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | D009688
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------