Provider Demographics
NPI:1942219555
Name:YAZDI, MAHSAN NAIMI (DDS)
Entity Type:Individual
Prefix:DR
First Name:MAHSAN
Middle Name:NAIMI
Last Name:YAZDI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:MAYA
Other - Middle Name:
Other - Last Name:YAZDI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:960 S. SARIVAL RD., SUITE 120,
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338
Mailing Address - Country:US
Mailing Address - Phone:623-594-0566
Mailing Address - Fax:623-594-0629
Practice Address - Street 1:960 S. SARIVAL RD., SUITE 120
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338
Practice Address - Country:US
Practice Address - Phone:623-594-0566
Practice Address - Fax:623-594-0629
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA460011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice