Healthcare Provider Details

I. General information

NPI: 1437640513
Provider Name (Legal Business Name): GN DENTAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2018
Last Update Date: 05/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7777 W DEER VALLEY RD STE 160
PEORIA AZ
85382-2104
US

IV. Provider business mailing address

20948 N 90TH AVE
PEORIA AZ
85382-6468
US

V. Phone/Fax

Practice location:
  • Phone: 623-561-0100
  • Fax:
Mailing address:
  • Phone: 520-499-9151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GEORGE S HARIRI
Title or Position: OFFICER
Credential: DMD
Phone: 520-499-9151