Reza Abedi, DDS
Individual provider Active NPI General Practice Dentistry · Apache Junction, AZ
NPI 1578659736 · NPPES record last updated Jul 9, 2007
Key facts
- NPI
- 1578659736
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- Practice address
- 879 N Plaza Dr
E014
Apache Junction, AZ 85220-4152 - Phone
- (480) 288-5955
- Fax
- (480) 288-4345
- NPI assigned
- Oct 5, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AZ
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160108001524 | AZ | Order and Referring Only - Oral Surgery |
1850693714 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| R Abedi DDS PLLC | General Practice | Current |
Accepting new patients |
| Kinder Pediatric Dental Specialist, PLLC | Past |
Accepting new patients |
Locations
209 W Apache Trl
Apache Junction, AZ 85120
Phone (480) 288-5955
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | AZ | Yes |
Addresses
Primary practice location
879 N Plaza Dr
E014
Apache Junction, AZ 85220-4152
Mailing address
879 N Plaza Dr
E101
Apache Junction, AZ 85220-4152
Phone (480) 288-5955
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 640658 | Medicaid | AZ |
Other providers in Apache Junction, AZ
- 1918 Winter Street Operating Co LLC
- A Better Learning Environment LLC
- Rebecca Ann Abernathy
- Abshire Internal Medicine PC
- Megan Abshire
- Vance Martin Abshire
- Absolute Speech & Language Therapy
All providers in Apache Junction, AZ · General Practice Dentistry in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 9, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.