Provider Demographics
NPI:1730307059
Name:GHASEM K. DARIAN, D.D.S., LTD
Entity Type:Organization
Organization Name:GHASEM K. DARIAN, D.D.S., LTD
Other - Org Name:PARADISE VALLEY DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAM
Authorized Official - Middle Name:D
Authorized Official - Last Name:SHORTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-992-5600
Mailing Address - Street 1:4001 E BELL ROAD
Mailing Address - Street 2:STE 120
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032
Mailing Address - Country:US
Mailing Address - Phone:602-992-5600
Mailing Address - Fax:602-992-2442
Practice Address - Street 1:4001 E BELL ROAD
Practice Address - Street 2:STE 120
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032
Practice Address - Country:US
Practice Address - Phone:602-992-5600
Practice Address - Fax:602-992-2442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ43541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ416992OtherAHCCCS