Provider Demographics
NPI:1568471035
Name:DAMADZADEH, RAMIN (DDS)
Entity Type:Individual
Prefix:MR
First Name:RAMIN
Middle Name:
Last Name:DAMADZADEH
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 1:4805 W THOMAS ROAD
Mailing Address - Street 2:SUITE C
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85031
Mailing Address - Country:US
Mailing Address - Phone:602-233-2212
Mailing Address - Fax:602-455-0070
Practice Address - Street 1:4338 W THOMAS RD STE E6
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85031-3878
Practice Address - Country:US
Practice Address - Phone:602-233-2212
Practice Address - Fax:602-455-0070
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4649122300000X
CA51814122300000X
AZD46491223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
No122300000XDental ProvidersDentist