Provider Demographics
NPI:1255433645
Name:MALEKZADEH, TANNAZ ZAHRA (DMD)
Entity type:Individual
Prefix:DR
First Name:TANNAZ
Middle Name:ZAHRA
Last Name:MALEKZADEH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20100 N 51ST AVE
Mailing Address - Street 2:STE F650
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-5125
Mailing Address - Country:US
Mailing Address - Phone:623-362-8969
Mailing Address - Fax:623-362-8971
Practice Address - Street 1:20100 N 51ST AVE
Practice Address - Street 2:STE F650
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-5125
Practice Address - Country:US
Practice Address - Phone:623-362-8969
Practice Address - Fax:623-362-8971
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2015-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ63411223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics