Healthcare Provider Details

I. General information

NPI: 1063186864
Provider Name (Legal Business Name): DELICATE DENTAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2021
Last Update Date: 08/04/2021
Certification Date: 08/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1855 W GREENWAY RD STE 107
PHOENIX AZ
85023-3475
US

IV. Provider business mailing address

1855 W GREENWAY RD STE 107
PHOENIX AZ
85023-3475
US

V. Phone/Fax

Practice location:
  • Phone: 602-805-1110
  • Fax: 602-805-1112
Mailing address:
  • Phone: 602-805-1110
  • Fax: 602-805-1112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. ESTHER SHALAMOV
Title or Position: OFFICE MANAGER
Credential: FNP
Phone: 917-660-0421