MEDICARE: DR. MASOOD SIRJANI DDS, PHARM.D.

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	122300000X	Dentist	7571	AZ
2	1223E0200X	Endodontics	D7571	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7571	OTHER	AZ	STATE BOARD LICENSE

General Provider Information

NPI Number	:	1992017149
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MASOOD SIRJANI DDS, PHARM.D.

Provider Business Mailing Address
First Line	:	706 E BELL RD STE 104
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85022-6641
Country	:	US
Telephone Number	:	602-482-7000
Fax Number	:	602-482-7021

Provider Business Practice Location Address
First Line	:	2979 W ELLIOT RD
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85224-1641
Country	:	US
Telephone Number	:	480-775-1300
Fax Number	:	480-775-1304

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

Provider Enumeration Date	:	07/04/2010
Last Update Date	:	03/17/2018

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