Provider Demographics
NPI:1174666275
Name:MY ORTHODONTIST, PC
Entity Type:Organization
Organization Name:MY ORTHODONTIST, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SALMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JAFFER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MPH
Authorized Official - Phone:602-573-1086
Mailing Address - Street 1:902 E MOUNTAIN SAGE DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-4430
Mailing Address - Country:US
Mailing Address - Phone:602-573-1086
Mailing Address - Fax:
Practice Address - Street 1:2765 S MARKET ST
Practice Address - Street 2:SUITE 103
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-6305
Practice Address - Country:US
Practice Address - Phone:480-857-9500
Practice Address - Fax:480-857-9502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD70701223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty