1811326226 NPI number — DYNAMIC DENTAL HEALTH ASSOCIATES OF ARIZONA

Table of content: (NPI 1811326226)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811326226 NPI number — DYNAMIC DENTAL HEALTH ASSOCIATES OF ARIZONA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DYNAMIC DENTAL HEALTH ASSOCIATES OF ARIZONA
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:
MOUNTAINSIDE 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:
1811326226
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/04/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
136 4TH ST N STE 201
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ST PETERSBURG
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33701-3889
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-800-8026
Provider Business Mailing Address Fax Number:
727-304-3164

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3961 E CHANDLER BLVD
Provider Second Line Business Practice Location Address:
STE. 104
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85048-0303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-759-4202
Provider Business Practice Location Address Fax Number:
480-759-3514
Provider Enumeration Date:
11/06/2013

Additional Information

Authorized Official

Authorized Official Last Name:
LESSO
Authorized Official First Name:
ROSA
Authorized Official Middle Name:
Authorized Official Title or Position:
NATIONAL DIRECTOR OF RCM
Authorized Official Telephone Number:
714-571-3471

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)





Copyright © 2007-2024 www.npivalidator.com