Provider Demographics
NPI:1740566298
Name:M. JOE MEHRANFAR DMD MS PLLC
Entity Type:Organization
Organization Name:M. JOE MEHRANFAR DMD MS PLLC
Other - Org Name:MEHRANFAR DENTAL GROUP LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DONELLA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:RUMARY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-388-4932
Mailing Address - Street 1:12320 N. 32ND ST
Mailing Address - Street 2:SUITE 2 & 3
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032
Mailing Address - Country:US
Mailing Address - Phone:623-388-4932
Mailing Address - Fax:623-547-5384
Practice Address - Street 1:12320 N. 32ND ST
Practice Address - Street 2:SUITE 2 & 3
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032
Practice Address - Country:US
Practice Address - Phone:623-388-4932
Practice Address - Fax:623-547-5384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-28
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty