Provider Demographics
NPI:1619112992
Name:BEHZAD GARAGOZLOO DDS LTD
Entity Type:Organization
Organization Name:BEHZAD GARAGOZLOO DDS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BEHZAD
Authorized Official - Middle Name:
Authorized Official - Last Name:GARAGOZLOO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:702-321-8602
Mailing Address - Street 1:10236 DUCHESS OF YORK AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89166-6532
Mailing Address - Country:US
Mailing Address - Phone:702-321-8602
Mailing Address - Fax:
Practice Address - Street 1:1215 S FORT APACHE RD
Practice Address - Street 2:#230
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-5488
Practice Address - Country:US
Practice Address - Phone:702-437-1007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-15
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVS7-64261QD0000X
AZ8884261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental