Provider Demographics
NPI:1437201746
Name:AESTHETIC DENTAL CREATIONS, PC
Entity type:Organization
Organization Name:AESTHETIC DENTAL CREATIONS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAYMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TASVIBI-TANHA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS,MS
Authorized Official - Phone:480-345-1605
Mailing Address - Street 1:1455 E GUADALUPE RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-3951
Mailing Address - Country:US
Mailing Address - Phone:480-345-1605
Mailing Address - Fax:480-831-7866
Practice Address - Street 1:1455 E GUADALUPE RD
Practice Address - Street 2:SUITE 3
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-3951
Practice Address - Country:US
Practice Address - Phone:480-345-1605
Practice Address - Fax:480-831-7866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ48371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty