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General NPI Number Information
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NPI Number | 1154622249
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Entity Type | Organization
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Legal Business Name | SOUTHWEST DENTAL PROFESSIONALS PLLC
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Dates
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Enumeration Date | 11/05/2010
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Last Update Date | 11/05/2010
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Provider Practice Location Address
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Address Line | 316 W ANGUS RD
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City | QUEEN CREEK
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State | AZ
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Zip | 85143-4989
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Country | US
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Telephone | 480-390-2060
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Fax |
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Provider Business Mailing Address
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Address Line | 316 W ANGUS RD
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City | QUEEN CREEK
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State | AZ
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Zip | 85143-4989
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Country | US
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Telephone | 480-390-2060
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Fax |
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Authorized Official
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Title or Position | OWNER/PRES
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Name | DR. LAWRENCE G GROOP
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Credential | DMD
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Telephone | 480-664-1449
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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 | D08719
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D07819
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License Number State | AZ
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