Healthcare Provider Details

I. General information

NPI: 1942134861
Provider Name (Legal Business Name): KIDS DENTAL AVONDALE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1579 N DYSART RD STE F
AVONDALE AZ
85392-1221
US

IV. Provider business mailing address

1579 N DYSART RD STE F
AVONDALE AZ
85392-1221
US

V. Phone/Fax

Practice location:
  • Phone: 623-935-9873
  • Fax:
Mailing address:
  • Phone: 623-935-9873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. LISA BETH BIENSTOCK
Title or Position: CEO
Credential: DMD
Phone: 602-833-2564