Provider Demographics
NPI:1922067404
Name:SEPIDEH MALEKPOUR, DDS, PLLC
Entity Type:Organization
Organization Name:SEPIDEH MALEKPOUR, DDS, PLLC
Other - Org Name:ARROWHEAD DESERT DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SEPIDEH
Authorized Official - Middle Name:
Authorized Official - Last Name:MALEKPOUR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:623-776-2494
Mailing Address - Street 1:18301 N 79TH AVE
Mailing Address - Street 2:SUITE G-186
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-8463
Mailing Address - Country:US
Mailing Address - Phone:623-776-2494
Mailing Address - Fax:
Practice Address - Street 1:18301 N 79TH AVE
Practice Address - Street 2:SUITE G-186
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8463
Practice Address - Country:US
Practice Address - Phone:623-776-2494
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD54341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty