Provider Demographics
NPI:1235356262
Name:HARSINI, HEDAYAT (DDS)
Entity Type:Individual
Prefix:
First Name:HEDAYAT
Middle Name:
Last Name:HARSINI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:EDDIE
Other - Middle Name:
Other - Last Name:HARSINI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:7102 W THOMAS RD STE 105
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85033-5543
Mailing Address - Country:US
Mailing Address - Phone:623-846-5555
Mailing Address - Fax:
Practice Address - Street 1:7102 W THOMAS RD STE 105
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85033-5543
Practice Address - Country:US
Practice Address - Phone:623-846-5555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD5084122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist