Provider Demographics
NPI:1831363183
Name:VARDA, PAUL A (DMD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:A
Last Name:VARDA
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 1:1300 N MCCLINTOCK DR
Mailing Address - Street 2:SUITE E12
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-7205
Mailing Address - Country:US
Mailing Address - Phone:480-897-2483
Mailing Address - Fax:480-820-1218
Practice Address - Street 1:1300 N MCCLINTOCK DR
Practice Address - Street 2:SUITE E12
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-7205
Practice Address - Country:US
Practice Address - Phone:480-897-2483
Practice Address - Fax:480-820-1218
Is Sole Proprietor?:No
Enumeration Date:2008-04-17
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ43841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0485310OtherBLUE CROSS BLUE SHIELD
859936OtherUNITED CONCORDIA