Provider Demographics
NPI:1174000574
Name:MIRDAMADI, PAUL (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:
Last Name:MIRDAMADI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:MR
Other - First Name:PARHAM
Other - Middle Name:
Other - Last Name:MIRDAMADI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8323 N SHANNON RD UNIT 11205
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85742-9586
Mailing Address - Country:US
Mailing Address - Phone:213-259-4867
Mailing Address - Fax:
Practice Address - Street 1:17767 N SCOTTSDALE RD STE 110
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-6590
Practice Address - Country:US
Practice Address - Phone:480-691-0020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-27
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS1047531223S0112X
AZD0117461223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery