Provider Demographics
NPI:1356516025
Name:DARIAN DDS & ASSOCIATES PLLC
Entity type:Organization
Organization Name:DARIAN DDS & ASSOCIATES PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-931-5467
Mailing Address - Street 1:20165 N 67TH AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-7002
Mailing Address - Country:US
Mailing Address - Phone:623-931-5467
Mailing Address - Fax:623-931-5469
Practice Address - Street 1:20165 N 67TH AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-7002
Practice Address - Country:US
Practice Address - Phone:623-931-5467
Practice Address - Fax:623-931-5469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ43541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ416992OtherAHCCCS