Provider Demographics
NPI:1942565072
Name:TAGHAVI, BEHNOUD (DMD)
Entity Type:Individual
Prefix:DR
First Name:BEHNOUD
Middle Name:
Last Name:TAGHAVI
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 1:1852 N MASTICK WAY
Mailing Address - Street 2:APT. 2043
Mailing Address - City:NOGALES
Mailing Address - State:AZ
Mailing Address - Zip Code:85621-1063
Mailing Address - Country:US
Mailing Address - Phone:520-761-2133
Mailing Address - Fax:520-281-2335
Practice Address - Street 1:3410 N 24TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-6606
Practice Address - Country:US
Practice Address - Phone:480-268-6260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-04
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD008479122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist