Provider Demographics
NPI:1356757157
Name:OWTAD, PAYAM (DDS, MS, DHED)
Entity type:Individual
Prefix:DR
First Name:PAYAM
Middle Name:
Last Name:OWTAD
Suffix:
Gender:M
Credentials:DDS, MS, DHED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2899 N 87TH ST STE 105
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85257-1767
Mailing Address - Country:US
Mailing Address - Phone:520-275-3843
Mailing Address - Fax:
Practice Address - Street 1:2899 N 87TH ST STE 105
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85257-1767
Practice Address - Country:US
Practice Address - Phone:650-275-3843
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-01
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0090001223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics