Provider Demographics
NPI:1235604166
Name:IMPLANT & RECONSTRUCTIVE DENTISTRY PLLC
Entity Type:Organization
Organization Name:IMPLANT & RECONSTRUCTIVE DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PAYAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ABEDI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-390-4378
Mailing Address - Street 1:1423 S HIGLEY RD STE 117
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-3450
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1423 S HIGLEY RD STE 117
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-3450
Practice Address - Country:US
Practice Address - Phone:480-390-4378
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-07
Last Update Date:2018-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty