Provider Demographics
NPI:1093314775
Name:NAIOOM DENTISTRY PLLC
Entity Type:Organization
Organization Name:NAIOOM DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FADI
Authorized Official - Middle Name:
Authorized Official - Last Name:NAIOOM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:480-993-6174
Mailing Address - Street 1:2158 N GILBERT RD
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85203-2109
Mailing Address - Country:US
Mailing Address - Phone:480-993-6174
Mailing Address - Fax:
Practice Address - Street 1:2158 N GILBERT RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85203-2109
Practice Address - Country:US
Practice Address - Phone:480-993-6174
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-22
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ944049Medicaid