Provider Demographics
NPI:1336474469
Name:MOAYEDPARDAZI, SEYEDISMAIL (DDS)
Entity Type:Individual
Prefix:
First Name:SEYEDISMAIL
Middle Name:
Last Name:MOAYEDPARDAZI
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 1:20261 E OCOTILLO RD STE 120
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-8806
Mailing Address - Country:US
Mailing Address - Phone:480-987-8768
Mailing Address - Fax:
Practice Address - Street 1:20261 E OCOTILLO RD STE 120
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-8806
Practice Address - Country:US
Practice Address - Phone:480-987-8768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-07
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD7865122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist