Healthcare Provider Details

I. General information

NPI: 1538528922
Provider Name (Legal Business Name): NORTH VALLEY CENTER FOR ORAL AND IMPLANT SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2016
Last Update Date: 02/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4025 W BELL RD
PHOENIX AZ
85053-2750
US

IV. Provider business mailing address

4025 W BELL RD
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 Code126800000X
TaxonomyDental Assistant
License Number
License Number State

VIII. Authorized Official

Name: MS. PEGGY S STANSBURY
Title or Position: SURGERY ASSISTANT
Credential:
Phone: 602-978-2890