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General NPI Number Information
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NPI Number | 1154580645
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Entity Type | Organization
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Legal Business Name | PEACH TREE DENTAL GROUP, LLP
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Dates
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Enumeration Date | 06/09/2008
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Last Update Date | 01/21/2010
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Provider Practice Location Address
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Address Line | 21582 S ELLSWORTH LOOP RD SUITE 126
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City | QUEEN CREEK
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State | AZ
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Zip | 85242-7881
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Country | US
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Telephone | 480-888-1416
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Fax |
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Provider Business Mailing Address
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Address Line | 2860 MICHELLE FL 2 2ND FLOOR
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City | IRVINE
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State | CA
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Zip | 92606-1008
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Country | US
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Telephone | 714-368-2077
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Fax | 714-368-2091
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Authorized Official
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Title or Position | OWNER DOCTOR
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Name | DR. BRIAN D BUEHLER
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Credential | DDS
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Telephone | 480-888-1416
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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