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General NPI Number Information
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NPI Number | 1235286469
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Entity Type | Organization
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Legal Business Name | DENTISTRY GROUP FOUNDATION, LLC
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Dates
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Enumeration Date | 01/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6328 E BROWN RD SUITE 101-102
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City | MESA
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State | AZ
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Zip | 85205-4841
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Country | US
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Telephone | 480-325-5700
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Fax | 480-325-5727
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Provider Business Mailing Address
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Address Line | 2323 W MESCAL ST SUITE 205
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City | PHOENIX
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State | AZ
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Zip | 85029-4764
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Country | US
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Telephone | 602-944-0073
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Fax | 602-944-0371
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Authorized Official
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Title or Position | INSURANCE MANAGER
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Name | FAWNE ELIZABETH PRYOR
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Credential |
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Telephone | 602-944-0073
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D5988
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License Number State | AZ
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