Provider Demographics
NPI:1528426962
Name:MUTLU, NEZAHET (DMD, MPH, MED)
Entity type:Individual
Prefix:DR
First Name:NEZAHET
Middle Name:
Last Name:MUTLU
Suffix:
Gender:F
Credentials:DMD, MPH, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 S. DOBSON,BLDG. C SUITE 18,
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224
Mailing Address - Country:US
Mailing Address - Phone:480-820-6778
Mailing Address - Fax:480-820-3606
Practice Address - Street 1:600 S DOBSON RD STE C18
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-5690
Practice Address - Country:US
Practice Address - Phone:480-820-6778
Practice Address - Fax:480-820-3606
Is Sole Proprietor?:No
Enumeration Date:2016-01-31
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0092801223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry