Organization
MARYLAND GARDEN DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MASSOUD EFTEKHARI D.D.S (OWNER)
(602) 249-1616
Entity
Organization
Contact information
Practice address
650 W MARYLAND AVE, SUITE 2, PHOENIX, AZ 85013-1399
(602) 249-1616
(602) 249-1138
Mailing address
650 W MARYLAND AVE, SUITE 2, PHOENIX, AZ 85013-1399
(602) 249-1616
(602) 249-1138
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
4954
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
16354
DORAL
AZ
01
—
169853
UNITED CONCORDIA
AZ
01
—
250891
CIGNA HMO
AZ
01
—
450966
HEALTH CHOICE
AZ
Enumeration date
05/11/2007
Last updated
05/27/2008
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