Provider Demographics
NPI:1790424042
Name:RANJBAR, NINA (DMD)
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:
Last Name:RANJBAR
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3750 W GREENWAY RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85053-3703
Mailing Address - Country:US
Mailing Address - Phone:602-223-1832
Mailing Address - Fax:
Practice Address - Street 1:3750 W GREENWAY RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85053-3703
Practice Address - Country:US
Practice Address - Phone:602-223-1832
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-02
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD011392122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist