1457955213 NPI number — GALAXY DENTISTRY FOR CHILDREN

Table of content: (NPI 1457955213)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457955213 NPI number — GALAXY DENTISTRY FOR CHILDREN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GALAXY DENTISTRY FOR CHILDREN
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:
Provider Other Organization Name Type Code:
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:
1457955213
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/23/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14100 N 83RD AVE STE 280
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PEORIA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85381-5660
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-820-0288
Provider Business Mailing Address Fax Number:
602-930-4965

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
515 E GRANT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85705-5797
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-820-0288
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/23/2020

Additional Information

Authorized Official

Authorized Official Last Name:
MARTINEZ
Authorized Official First Name:
JESSICA
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING MANAGER
Authorized Official Telephone Number:
602-820-0288

Provider Taxonomy Codes

  • Taxonomy code: 1223D0004X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 190421 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com