Provider Demographics
NPI:1326568411
Name:ARYAAN, AMIR (DDS)
Entity Type:Individual
Prefix:
First Name:AMIR
Middle Name:
Last Name:ARYAAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5332 E BASELINE RD APT 2003
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-4727
Mailing Address - Country:US
Mailing Address - Phone:734-604-8297
Mailing Address - Fax:
Practice Address - Street 1:4620 S FLORIDA AVE STE 120
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-2166
Practice Address - Country:US
Practice Address - Phone:863-216-5765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-21
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL275131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice