Healthcare Provider Details

I. General information

NPI: 1699242578
Provider Name (Legal Business Name): BLUEDOT DENTAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2018
Last Update Date: 10/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3327 E BASELINE RD
GILBERT AZ
85234-2633
US

IV. Provider business mailing address

3327 E BASELINE RD
GILBERT AZ
85234-2633
US

V. Phone/Fax

Practice location:
  • Phone: 480-497-0226
  • Fax: 480-497-1777
Mailing address:
  • Phone: 480-497-0226
  • Fax: 480-497-1777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: LIZ G WESTBROOK
Title or Position: INSURANCE DIRECTOR
Credential:
Phone: 480-497-0226