Healthcare Provider Details

I. General information

NPI: 1922101567
Provider Name (Legal Business Name): SPECIALISTS DENTAL IMPLANT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2905 W WARNER RD SUITE 15
CHANDLER AZ
85224
US

IV. Provider business mailing address

2905 W WARNER RD SUITE 15
CHANDLER AZ
85224
US

V. Phone/Fax

Practice location:
  • Phone: 480-831-8100
  • Fax: 480-831-6054
Mailing address:
  • Phone: 480-831-8100
  • Fax: 480-831-6054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number5099
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number1733
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number4475
License Number StateAZ

VIII. Authorized Official

Name: DR. LEWIS PAUL ROBINSON
Title or Position: DENTIST PERIODONTIST OWNER PARTNER
Credential: DMD MS
Phone: 480-831-8100