Provider Demographics
NPI:1659460202
Name:FOROUGHI, SHAHYAR (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHAHYAR
Middle Name:
Last Name:FOROUGHI
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 1:4530 E RAY RD STE 170
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-6097
Mailing Address - Country:US
Mailing Address - Phone:480-940-4321
Mailing Address - Fax:480-940-3322
Practice Address - Street 1:4530 E RAY RD STE 170
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-6097
Practice Address - Country:US
Practice Address - Phone:480-940-4321
Practice Address - Fax:480-940-3322
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5717122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist