Provider Demographics
NPI:1790247146
Name:XO DENTISTRY - AZ P.C.
Entity Type:Organization
Organization Name:XO DENTISTRY - AZ P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAYAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ABEDI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:623-463-2222
Mailing Address - Street 1:3530 S VAL VISTA DR STE 201
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-7322
Mailing Address - Country:US
Mailing Address - Phone:480-900-0001
Mailing Address - Fax:
Practice Address - Street 1:3530 S VAL VISTA DR STE 201
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297
Practice Address - Country:US
Practice Address - Phone:480-900-0001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-04
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty