Organization
INNOVATIVE DENTAL GROUP, PLLC
Active
Other names
Advanced Family Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PAYAM KIMIAEI-ASADI DMD (DENTIST)
(520) 353-3002
Entity
Organization
Contact information
Practice address
5209 N ORACLE RD, TUCSON, AZ 85704-3707
(520) 353-3002
Mailing address
5209 N ORACLE RD, TUCSON, AZ 85704-3707
(520) 353-3002
(520) 293-3723
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D008483
AZ
Other
Enumeration date
01/30/2018
Last updated
02/20/2020
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