Provider Demographics
NPI:1699873505
Name:AMERICAN FAMILY DENTISTRY
Entity type:Organization
Organization Name:AMERICAN FAMILY DENTISTRY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEYDOKHT
Authorized Official - Middle Name:
Authorized Official - Last Name:RAOUFI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-998-4867
Mailing Address - Street 1:14201 N HAYDEN RD
Mailing Address - Street 2:SUITE D3
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85360
Mailing Address - Country:US
Mailing Address - Phone:480-998-4867
Mailing Address - Fax:480-998-4872
Practice Address - Street 1:14201 N HAYDEN RD
Practice Address - Street 2:SUITE D3
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85360
Practice Address - Country:US
Practice Address - Phone:480-998-4867
Practice Address - Fax:480-998-4872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty