Provider Demographics
NPI:1891908315
Name:ZAMANI, MORTEZA (DMD)
Entity Type:Individual
Prefix:DR
First Name:MORTEZA
Middle Name:
Last Name:ZAMANI
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 1:130 W GUADALUPE RD
Mailing Address - Street 2:APT# 2058
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-3328
Mailing Address - Country:US
Mailing Address - Phone:602-301-2441
Mailing Address - Fax:
Practice Address - Street 1:130 W GUADALUPE RD
Practice Address - Street 2:APT#2058
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-3328
Practice Address - Country:US
Practice Address - Phone:602-301-2441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD7203122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist