Provider Demographics
NPI:1548459316
Name:EXCEPTIONAL DENTISTRY INC.
Entity type:Organization
Organization Name:EXCEPTIONAL DENTISTRY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:MAZAHERI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-633-1481
Mailing Address - Street 1:725 W ELLIOT RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-5301
Mailing Address - Country:US
Mailing Address - Phone:480-633-1481
Mailing Address - Fax:480-633-1483
Practice Address - Street 1:725 W ELLIOT RD
Practice Address - Street 2:SUITE 104
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-5301
Practice Address - Country:US
Practice Address - Phone:480-633-1481
Practice Address - Fax:480-633-1483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-17
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD6509122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty