# INNOVATIVE DENTAL GROUP, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Advanced Family Dentistry
- **Organization subpart:** No

## Provider details

- **NPI number:** 1639677115
- **Authorized official:** DR. PAYAM KIMIAEI-ASADI DMD (DENTIST)
- **Authorized official phone:** (520) 293-9277

## Contact information

- **Practice address:** 5209 N ORACLE RD, TUCSON, AZ 85704-3707
- **Practice address phone:** (520) 293-9277
- **Mailing address:** 5209 N ORACLE RD, TUCSON, AZ 85704-3707
- **Mailing address phone:** (520) 293-9277
- **Mailing address fax:** (520) 293-3723

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | D008483 | AZ | Yes |

## Other

- **Enumeration date:** 01/30/2018
- **Last updated:** 07/30/2026