Individual
DR. MOSTAFA HEDAYAT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5045 W BASELINE RD, LAVEEN, AZ 85339-7392
(602) 237-0613
Mailing address
5045 W BASELINE RD, LAVEEN, AZ 85339-7392
(602) 237-0613
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D011120
AZ
1223G0001X
General Practice Dentistry
D011120
AZ
Other
Enumeration date
07/19/2021
Last updated
07/19/2021
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