1316101728 NPI number — ARIZONA DENTAL PROFESSIONALS, P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316101728 NPI number — ARIZONA DENTAL PROFESSIONALS, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARIZONA DENTAL PROFESSIONALS, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CROSSROADS FAMILY DENTAL
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316101728
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/04/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3750 HIGHWAY 95
Provider Second Line Business Mailing Address:
SUITE 106
Provider Business Mailing Address City Name:
BULLHEAD CITY
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86442-8218
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-704-2580
Provider Business Mailing Address Fax Number:
928-704-2583

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3750 HIGHWAY 95
Provider Second Line Business Practice Location Address:
SUITE 106
Provider Business Practice Location Address City Name:
BULLHEAD CITY
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86442-8218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-704-2580
Provider Business Practice Location Address Fax Number:
928-704-2583
Provider Enumeration Date:
07/15/2008

Additional Information

Authorized Official

Authorized Official Last Name:
WOODS
Authorized Official First Name:
CARMEN
Authorized Official Middle Name:
Authorized Official Title or Position:
INS COORDINATOR
Authorized Official Telephone Number:
217-540-5100

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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