Healthcare Provider Details

I. General information

NPI: 1407787484
Provider Name (Legal Business Name): NORTH PHOENIX DENTAL STUDIO PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20333 N 19TH AVE STE 203
PHOENIX AZ
85027-3627
US

IV. Provider business mailing address

20333 N 19TH AVE STE 203
PHOENIX AZ
85027-3627
US

V. Phone/Fax

Practice location:
  • Phone: 623-244-4891
  • Fax: 623-280-2305
Mailing address:
  • Phone: 623-244-4891
  • Fax: 623-280-2305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: LELANNIE FATIMA YRAY COATS
Title or Position: DENTIST
Credential: DDS
Phone: 623-244-4891