Provider Demographics
NPI:1497122287
Name:G D DENTAL PLLC
Entity Type:Organization
Organization Name:G D DENTAL PLLC
Other - Org Name:PHOENIX MIDTOWN DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GHASEM
Authorized Official - Middle Name:K
Authorized Official - Last Name:DARIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:602-265-8566
Mailing Address - Street 1:5555 N 7TH ST
Mailing Address - Street 2:STE 142
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-2584
Mailing Address - Country:US
Mailing Address - Phone:602-265-8566
Mailing Address - Fax:602-248-0587
Practice Address - Street 1:5555 N 7TH ST
Practice Address - Street 2:STE 142
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-2584
Practice Address - Country:US
Practice Address - Phone:602-265-8566
Practice Address - Fax:602-248-0587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-27
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD04354122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty