Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 7592 | AZ |
Y | 1223P0106X | Oral and Maxillofacial Pathology | D07592 | AZ |
NPI | 1043457427 |
---|---|
Provider Name | Dr. Mindy Zahra Motahari |
First Address | Gilbert, AZ 85297-4901 |
Second Address | Mesa, AZ 85206-3631 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/01/2009 |
Last Update Date | 03/09/2021 |