Provider Demographics
NPI:1629570023
Name:DESERT ELITE FAMILY DENTAL PLLC
Entity Type:Organization
Organization Name:DESERT ELITE FAMILY DENTAL PLLC
Other - Org Name:ELITE DENTAL, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/DMD
Authorized Official - Prefix:DR
Authorized Official - First Name:MAZIAR
Authorized Official - Middle Name:
Authorized Official - Last Name:MINOOFAR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:323-205-6294
Mailing Address - Street 1:1531 GEORGE DIETER DR APT 1004
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-7673
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1300 EL PASEO RD STE N
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-6039
Practice Address - Country:US
Practice Address - Phone:323-205-6294
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-02
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty