Provider Demographics
NPI:1487706123
Name:TASVIBI-TANHA, PAYMAN (DDS,MS)
Entity type:Individual
Prefix:DR
First Name:PAYMAN
Middle Name:
Last Name:TASVIBI-TANHA
Suffix:
Gender:M
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ48371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice