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NPI Code Detail

MEDICARE: DR. GOLBARG POURKHOMAMI DMD

MEDICARE: DR. GOLBARG POURKHOMAMI DMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist6008AZ

General Provider Information

NPI Number : 1093873945
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GOLBARG POURKHOMAMI DMD
Provider Business Mailing Address
First Line : 10240 N 31ST AVE STE 100
Second Line :
City : PHOENIX
State : AZ
Zip : 85051-9564
Country : US
Telephone Number : 602-944-7199
Fax Number : 602-944-7781
Provider Business Practice Location Address
First Line : 10240 N 31ST AVE STE 100
Second Line :
City : PHOENIX
State : AZ
Zip : 85051-9564
Country : US
Telephone Number : 602-944-7199
Fax Number : 602-944-7781
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/04/2006
Last Update Date : 07/08/2007

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