MEDICARE: DR. TANNAZ ZAHRA MALEKZADEH 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
1	1223P0300X	Periodontics	6341	AZ

General Provider Information

NPI Number	:	1255433645
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TANNAZ ZAHRA MALEKZADEH DMD

Provider Business Mailing Address
First Line	:	20100 N 51ST AVE
Second Line	:	STE F650
City	:	GLENDALE
State	:	AZ
Zip	:	85308-5125
Country	:	US
Telephone Number	:	623-362-8969
Fax Number	:	623-362-8971

Provider Business Practice Location Address
First Line	:	20100 N 51ST AVE
Second Line	:	STE F650
City	:	GLENDALE
State	:	AZ
Zip	:	85308-5125
Country	:	US
Telephone Number	:	623-362-8969
Fax Number	:	623-362-8971

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/05/2006
Last Update Date	:	03/06/2015

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