Provider Demographics
NPI:1225074040
Name:ABDOLLAHZADEH, RASSA (DMD)
Entity Type:Individual
Prefix:
First Name:RASSA
Middle Name:
Last Name:ABDOLLAHZADEH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2571 S VAL VISTA DR STE 101
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-6233
Mailing Address - Country:US
Mailing Address - Phone:480-597-5536
Mailing Address - Fax:480-597-5624
Practice Address - Street 1:2571 S VAL VISTA DR STE 101
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-6233
Practice Address - Country:US
Practice Address - Phone:480-597-5536
Practice Address - Fax:480-597-5624
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ54711223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ590291OtherAHCCCS PROVIDER ID NUMBER