Provider Demographics
NPI:1801008248
Name:ADEL SHAYEGAN DMD PC
Entity Type:Organization
Organization Name:ADEL SHAYEGAN DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ADEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAYEGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:602-955-1780
Mailing Address - Street 1:4203 E INDIAN SCHOOL RD
Mailing Address - Street 2:# 220
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-5359
Mailing Address - Country:US
Mailing Address - Phone:602-955-1780
Mailing Address - Fax:602-955-1153
Practice Address - Street 1:4203 E INDIAN SCHOOL RD
Practice Address - Street 2:# 220
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-5359
Practice Address - Country:US
Practice Address - Phone:602-955-1780
Practice Address - Fax:602-955-1153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ47721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty