Healthcare Provider Details

I. General information

NPI: 1710133004
Provider Name (Legal Business Name): NORTH VALLEY CENTER FOR ORAL AND IMPLANT SURGERY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2008
Last Update Date: 03/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4025 W BELL RD SUITE 9
PHOENIX AZ
85053-2750
US

IV. Provider business mailing address

4025 W BELL RD SUITE 9
PHOENIX AZ
85053-2750
US

V. Phone/Fax

Practice location:
  • Phone: 602-978-2890
  • Fax: 602-978-5794
Mailing address:
  • Phone: 602-978-2890
  • Fax: 602-978-5794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number5583
License Number StateAZ

VIII. Authorized Official

Name: DR. DONALD J JOHNSON
Title or Position: ORAL AND MAXILLOFACIAL SURGEON
Credential: DMD
Phone: 602-978-2890