Provider Demographics
NPI:1851510788
Name:JAFARI, REZA (DMD)
Entity Type:Individual
Prefix:DR
First Name:REZA
Middle Name:
Last Name:JAFARI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4915 E MICHELLE DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-7611
Mailing Address - Country:US
Mailing Address - Phone:480-862-6846
Mailing Address - Fax:
Practice Address - Street 1:18471 E QUEEN CREEK RD
Practice Address - Street 2:#106
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85242-3628
Practice Address - Country:US
Practice Address - Phone:480-722-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6385122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist