Healthcare Provider Details

I. General information

NPI: 1548284094
Provider Name (Legal Business Name): ARIZONA DENTAL SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7600 N 15TH ST STE 170
PHOENIX AZ
85020-4305
US

IV. Provider business mailing address

7600 N 15TH ST STE 170
PHOENIX AZ
85020-4305
US

V. Phone/Fax

Practice location:
  • Phone: 602-870-1238
  • Fax: 602-997-4951
Mailing address:
  • Phone: 602-870-1238
  • Fax: 602-997-4951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State

VIII. Authorized Official

Name: DOROTHY LUGO
Title or Position: ACCOUNTS RECIEVABLE SUPERVISOR
Credential:
Phone: 602-870-1223