Healthcare Provider Details

I. General information

NPI: 1609989748
Provider Name (Legal Business Name): A PAUL SERRANO DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 12/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 E MISSOURI STE 101
PHOENIX AZ
85014-2443
US

IV. Provider business mailing address

1515 E MISSOURI STE 101
PHOENIX AZ
85014-2443
US

V. Phone/Fax

Practice location:
  • Phone: 602-274-7840
  • Fax: 602-274-7956
Mailing address:
  • Phone: 602-274-7840
  • Fax: 602-274-7956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberD5543
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberD2814
License Number StateAZ

VIII. Authorized Official

Name: MR. ALBERT PAUL SERRANO
Title or Position: OWNER/DDS
Credential: DDS
Phone: 602-274-7840