MEDICARE: ARIAN DENTAL GROUP

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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1396077186
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARIAN DENTAL GROUP

Provider Business Mailing Address
First Line	:	1423 N 16TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85006-3004
Country	:	US
Telephone Number	:	602-232-1980
Fax Number	:	602-253-4716

Provider Business Practice Location Address
First Line	:	1423 N 16TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85006-3004
Country	:	US
Telephone Number	:	602-232-1980
Fax Number	:	602-253-4716

Authorized Official
Title or Position	:	ADMINSTRATOR
Name	:	MS. SHEILA A SHAGHAGHI
Credential	:
Telephone Number	:	602-232-1980

Provider Enumeration Date	:	02/04/2010
Last Update Date	:	02/04/2010

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