Provider Demographics
NPI:1912127895
Name:GARAGOZLOO, BEHZAD (DDS)
Entity Type:Individual
Prefix:
First Name:BEHZAD
Middle Name:
Last Name:GARAGOZLOO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 S FORT APACHE RD
Mailing Address - Street 2:#230
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-5488
Mailing Address - Country:US
Mailing Address - Phone:702-321-8602
Mailing Address - Fax:
Practice Address - Street 1:1215 S FORT APACHE RD
Practice Address - Street 2:#230
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-5488
Practice Address - Country:US
Practice Address - Phone:702-321-8602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVS7-641223E0200X
AZ88841223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics