Healthcare Provider Details

I. General information

NPI: 1326609843
Provider Name (Legal Business Name): HDP FOX DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2019
Last Update Date: 05/08/2023
Certification Date: 05/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 W THUNDERBIRD RD STE 200
PEORIA AZ
85381-4435
US

IV. Provider business mailing address

PO BOX 734753
DALLAS TX
75373-4753
US

V. Phone/Fax

Practice location:
  • Phone: 623-523-0290
  • Fax:
Mailing address:
  • Phone: 623-523-0290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: VICENTA REYES
Title or Position: CREDENTIALING SENIOR TEAM LEAD
Credential:
Phone: 972-869-3789