Provider Demographics
NPI:1588950521
Name:BAZARGAN, HALEH (DDS)
Entity type:Individual
Prefix:
First Name:HALEH
Middle Name:
Last Name:BAZARGAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:HALEH
Other - Middle Name:
Other - Last Name:BAZARGAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:5544 E SHEENA DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-2959
Mailing Address - Country:US
Mailing Address - Phone:631-388-0906
Mailing Address - Fax:
Practice Address - Street 1:430 W FINNIE FLAT RD
Practice Address - Street 2:
Practice Address - City:CAMP VERDE
Practice Address - State:AZ
Practice Address - Zip Code:86322-7362
Practice Address - Country:US
Practice Address - Phone:631-388-0906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-28
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8563122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ758643Medicaid