Organization
HALEH BAZARGAN DDS PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HALEH BAZARGAN DDS (OWNER)
(631) 388-0906
Entity
Organization
Contact information
Practice address
430 W FINNIE FLAT RD, CAMP VERDE, AZ 86322-7362
(928) 567-4108
Mailing address
430 W FINNIE FLAT RD, CAMP VERDE, AZ 86322-7362
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
2553
AZ
122300000X
Dentist
Primary
8563
AZ
1223P0221X
Pediatric Dentistry
8377
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
729347
—
AZ
05
—
758643
—
AZ
Enumeration date
06/05/2014
Last updated
06/05/2014
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