Provider Demographics
NPI:1053766287
Name:DEER VALLEY DENTAL GROUP, LLP
Entity type:Organization
Organization Name:DEER VALLEY DENTAL GROUP, LLP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FARZAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOJGANI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:623-255-3390
Mailing Address - Street 1:PO BOX 920050
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75392-0050
Mailing Address - Country:US
Mailing Address - Phone:714-845-8890
Mailing Address - Fax:
Practice Address - Street 1:2805 W AGUA FRIA FWY STE 8A
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-3938
Practice Address - Country:US
Practice Address - Phone:623-255-3390
Practice Address - Fax:623-900-7330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-25
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty