Provider Demographics
NPI:1558760066
Name:RAJYAGURU, PAYAL (DMD)
Entity Type:Individual
Prefix:
First Name:PAYAL
Middle Name:
Last Name:RAJYAGURU
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1431 E CAPTAIN DREYFUS AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-4928
Mailing Address - Country:US
Mailing Address - Phone:602-614-3192
Mailing Address - Fax:
Practice Address - Street 1:3011 S LINDSAY RD
Practice Address - Street 2:SUITE 104
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-4332
Practice Address - Country:US
Practice Address - Phone:480-219-6336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-20
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD009072122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist