MEDICARE: DR. MICHAEL A. MAZAHERI D.D.S.

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	D6509	AZ

General Provider Information

NPI Number	:	1871521195
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL A. MAZAHERI D.D.S.

Provider Business Mailing Address
First Line	:	7368 E ADELE CT
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85255-6124
Country	:	US
Telephone Number	:	614-975-1330
Fax Number	:

Provider Business Practice Location Address
First Line	:	725 W ELLIOT RD
Second Line	:	#104
City	:	GILBERT
State	:	AZ
Zip	:	85233-5301
Country	:	US
Telephone Number	:	480-633-1481
Fax Number	:	480-633-1483

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

Provider Enumeration Date	:	06/28/2006
Last Update Date	:	07/08/2007

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