Provider Demographics
NPI:1801900246
Name:SHAYEGAN, ADEL (DMD)
Entity type:Individual
Prefix:DR
First Name:ADEL
Middle Name:
Last Name:SHAYEGAN
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 1:10750 W MCDOWELL
Mailing Address - Street 2:#B200
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85323
Mailing Address - Country:US
Mailing Address - Phone:623-388-5888
Mailing Address - Fax:623-388-5904
Practice Address - Street 1:10750 W MCDOWELL
Practice Address - Street 2:#B200
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85323
Practice Address - Country:US
Practice Address - Phone:623-388-5888
Practice Address - Fax:623-388-5904
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4772122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ388513OtherAHCCCS