Provider Demographics
NPI:1417732363
Name:TANNAZ MALEKZADEH DMD
Entity Type:Organization
Organization Name:TANNAZ MALEKZADEH DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TANNAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:MALEKZADEH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:860-478-6363
Mailing Address - Street 1:20100 N 51ST AVE STE F650
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-5086
Mailing Address - Country:US
Mailing Address - Phone:860-478-6363
Mailing Address - Fax:
Practice Address - Street 1:20100 N 51ST AVE STE F650
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-5086
Practice Address - Country:US
Practice Address - Phone:860-478-6363
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-29
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty