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NPI Code Detail

MEDICARE: PHOENICIAN DENTAL GROUP INC

MEDICARE: PHOENICIAN DENTAL GROUP INC
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
1122300000XDentistD008519AZ

General Provider Information

NPI Number : 1952832008
Entity Type Code : Organization
Provider Name (Legal Business Name) : PHOENICIAN DENTAL GROUP INC
Provider Business Mailing Address
First Line : 9233 E PINE VALLEY RD
Second Line :
City : SCOTTSDALE
State : AZ
Zip : 85260-2847
Country : US
Telephone Number : 480-228-0661
Fax Number :
Provider Business Practice Location Address
First Line : 9160 N 43RD AVE
Second Line :
City : GLENDALE
State : AZ
Zip : 85302-3801
Country : US
Telephone Number : 623-931-9221
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DR. POURYA SHAHNAZ
Credential : D.M.D.
Telephone Number : 480-228-0661
Provider Enumeration Date : 03/21/2017
Last Update Date : 03/21/2017

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Directions to “PHOENICIAN DENTAL GROUP INC ” Practice Location

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