Provider Demographics
NPI:1093397507
Name:THE WIGGLY TOOTH PEDIATRIC DENTISTRY LLC
Entity Type:Organization
Organization Name:THE WIGGLY TOOTH PEDIATRIC DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:NAJMEH
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAHBAZI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:480-358-7224
Mailing Address - Street 1:29211 N 23RD DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085-2753
Mailing Address - Country:US
Mailing Address - Phone:480-358-7224
Mailing Address - Fax:
Practice Address - Street 1:10401 E MCDOWELL MOUNTAIN RANCH RD STE 130
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-7525
Practice Address - Country:US
Practice Address - Phone:480-358-7224
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-23
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty