Healthcare Provider Details

I. General information

NPI: 1326533605
Provider Name (Legal Business Name): THE DENTAL CENTER OF QUEEN CREEK, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2018
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4727 E. PECOS RD. SUITE 101
GILBERT AZ
85295
US

IV. Provider business mailing address

4727 E. PECOS RD. SUITE 101
GILBERT AZ
85295
US

V. Phone/Fax

Practice location:
  • Phone: 480-807-4000
  • Fax: 480-807-4002
Mailing address:
  • Phone: 480-807-4000
  • Fax: 480-807-4002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD7280
License Number StateAZ

VIII. Authorized Official

Name: DR. BRIAN J GOODMAN
Title or Position: OWNER
Credential: DDS
Phone: 480-807-4000