Healthcare Provider Details

I. General information

NPI: 1063976488
Provider Name (Legal Business Name): C AND E DENTAL PROFESSIONALS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2019
Last Update Date: 05/22/2024
Certification Date: 05/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13821 N 35TH DR STE 2
PHOENIX AZ
85053-5541
US

IV. Provider business mailing address

13821 N 35TH DR STE 2
PHOENIX AZ
85053-5541
US

V. Phone/Fax

Practice location:
  • Phone: 602-547-9007
  • Fax:
Mailing address:
  • Phone: 602-547-9007
  • Fax: 602-547-3438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DEBORAH BONNET
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 602-882-0676