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General NPI Number Information
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NPI Number | 1235358029
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Entity Type | Organization
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Legal Business Name | ORTHODONTIC CENTERS OF AZ
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Dates
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Enumeration Date | 04/24/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5505 W CHANDLER BLVD 11-12
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City | CHANDLER
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State | AZ
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Zip | 85226-3683
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Country | US
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Telephone | 480-705-8585
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Fax | 480-705-8586
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Provider Business Mailing Address
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Address Line | 5505 W CHANDLER BLVD 11-12
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City | CHANDLER
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State | AZ
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Zip | 85226-3683
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Country | US
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Telephone | 480-705-8585
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Fax | 480-705-8586
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Authorized Official
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Title or Position | ORTHODONTIST
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Name | DAVID B DOWLING
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Credential | DDS, MS, PC
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Telephone | 480-705-8585
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 1692
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License Number State | AZ
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