=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083767768
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WEST VALLEY PEDIATRIC DENTISTRY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/18/2007
-----------------------------------------------------
Last Update Date | 09/06/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13575 W INDIAN SCHOOL RD STE 1000
-----------------------------------------------------
City | LITCHFIELD PARK
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85340-4926
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-935-9873
-----------------------------------------------------
Fax | 623-935-3626
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13575 W INDIAN SCHOOL RD STE 1000
-----------------------------------------------------
City | LITCHFIELD PARK
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85340-4926
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-935-9873
-----------------------------------------------------
Fax | 623-935-3626
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST OWNER
-----------------------------------------------------
Name | DR. JEFFREY NEIL BROWNSTEIN
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 623-935-9873
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number | D5164
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------